Provider Demographics
NPI:1316925670
Name:AMRHEIN, LYLE W (OD)
Entity type:Individual
Prefix:
First Name:LYLE
Middle Name:W
Last Name:AMRHEIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 PARKVIEW CT
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47327-1149
Mailing Address - Country:US
Mailing Address - Phone:765-478-3717
Mailing Address - Fax:
Practice Address - Street 1:3 PARKVIEW CT
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE CITY
Practice Address - State:IN
Practice Address - Zip Code:47327-1149
Practice Address - Country:US
Practice Address - Phone:765-478-3717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-06
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002031152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100256550Medicaid
IN100256550Medicaid
IN903710Medicare PIN