Provider Demographics
NPI:1528290822
Name:LYONS-WAIT, VICKI ANN (OD)
Entity type:Individual
Prefix:DR
First Name:VICKI
Middle Name:ANN
Last Name:LYONS-WAIT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:VICKI
Other - Middle Name:ANN
Other - Last Name:VALE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:309 WEST QUINTO STREET
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105
Mailing Address - Country:US
Mailing Address - Phone:805-682-2618
Mailing Address - Fax:805-682-0125
Practice Address - Street 1:309 WEST QUINTO STREET
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105
Practice Address - Country:US
Practice Address - Phone:805-682-2618
Practice Address - Fax:805-682-0125
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11178T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist