Provider Demographics
NPI:1255021606
Name:TUBENE, LYDIE TSHIYOYO (OD)
Entity type:Individual
Prefix:
First Name:LYDIE
Middle Name:TSHIYOYO
Last Name:TUBENE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:LYDIE
Other - Middle Name:T
Other - Last Name:TUBENE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE BOX 888
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-273-3937
Mailing Address - Fax:
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-273-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-09
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618003365152W00000X
NYTUV009832152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist