Provider Demographics
NPI:1962402644
Name:LYONS, STACY A (OD)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:A
Last Name:LYONS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:930 COMMON WEALTH AVE SUITE 2A
Mailing Address - Street 2:NEW ENGLAND EYE INSTITUE
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215
Mailing Address - Country:US
Mailing Address - Phone:617-262-2020
Mailing Address - Fax:617-236-6323
Practice Address - Street 1:31 FLAGG DRIVE
Practice Address - Street 2:NEW ENGLAND EYE FULLER MIDDLE SCHOOL
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702
Practice Address - Country:US
Practice Address - Phone:508-620-4956
Practice Address - Fax:508-879-4909
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3440152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA324370Medicaid
U17646Medicare UPIN
MA446658Medicare ID - Type Unspecified