Provider Demographics
NPI:1912982547
Name:LYONS, JAMES MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MICHAEL
Last Name:LYONS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-06
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1953152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN06202Medicare PIN
410003864Medicare UPIN