Provider Demographics
NPI:1396974200
Name:LYLES, AARON J (OD)
Entity type:Individual
Prefix:DR
First Name:AARON
Middle Name:J
Last Name:LYLES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:KY
Mailing Address - Zip Code:42025-1123
Mailing Address - Country:US
Mailing Address - Phone:270-527-7421
Mailing Address - Fax:
Practice Address - Street 1:109 W 5TH ST
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:KY
Practice Address - Zip Code:42025-1123
Practice Address - Country:US
Practice Address - Phone:270-527-7421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-13
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1767DT174400000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100081660Medicaid
KY000000624678OtherANTHEM BCBS
KYP00759130OtherRAILROAD MEDICARE
KY0413360001Medicare NSC
KY9028908Medicare PIN