Provider Demographics
NPI:1700803889
Name:TYMIAK, LYDA D (MD PA)
Entity Type:Individual
Prefix:DR
First Name:LYDA
Middle Name:D
Last Name:TYMIAK
Suffix:
Gender:F
Credentials:MD PA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2650 TAMPA RD
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-3144
Mailing Address - Country:US
Mailing Address - Phone:727-785-4419
Mailing Address - Fax:727-789-3351
Practice Address - Street 1:2650 TAMPA RD
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3144
Practice Address - Country:US
Practice Address - Phone:727-785-4419
Practice Address - Fax:727-789-3351
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME30547207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL624122OtherAETNA
FL180012673OtherRAILROAD MEDICARE
FL62239OtherBLUE CROSS
FL624122OtherAETNA
FLD57359Medicare UPIN