Provider Demographics
NPI:1649316753
Name:LYON, CHRISTOPHER (PHD,MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:
Last Name:LYON
Suffix:
Gender:M
Credentials:PHD,MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 W LA VETA AVE
Mailing Address - Street 2:300
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4213
Mailing Address - Country:US
Mailing Address - Phone:714-771-1144
Mailing Address - Fax:714-771-6785
Practice Address - Street 1:1201 W LA VETA AVE
Practice Address - Street 2:300
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4213
Practice Address - Country:US
Practice Address - Phone:714-771-1144
Practice Address - Fax:714-771-6785
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37277207W00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA330116450OtherTAXID
CAB50346Medicare UPIN
CAA37277Medicare ID - Type Unspecified