Provider Demographics
NPI:1700145687
Name:JAMES M, LYONS, OD
Entity Type:Organization
Organization Name:JAMES M, LYONS, OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:952-435-8747
Mailing Address - Street 1:10335 166TH ST W
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-8785
Mailing Address - Country:US
Mailing Address - Phone:952-435-8747
Mailing Address - Fax:952-435-8747
Practice Address - Street 1:14333 HWY 13 S
Practice Address - Street 2:
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378-2153
Practice Address - Country:US
Practice Address - Phone:952-226-1411
Practice Address - Fax:952-226-1413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-11
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1953261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN410003864Medicare UPIN
06202Medicare PIN