Provider Demographics
NPI:1811995905
Name:LYON, DAVID B (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:B
Last Name:LYON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:11261 NALL AVE
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1675
Mailing Address - Country:US
Mailing Address - Phone:913-261-2020
Mailing Address - Fax:913-261-2090
Practice Address - Street 1:11261 NALL AVE
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-1675
Practice Address - Country:US
Practice Address - Phone:913-261-2020
Practice Address - Fax:913-261-2020
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO106795207W00000X
KS0425237207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207682311Medicaid
MO207682311Medicaid
KSP00010638Medicare PIN
KS4059523EMedicare PIN
MO180019981Medicare PIN
B54716Medicare UPIN
MO4059523HMedicare PIN
MO4059523DMedicare PIN