1194903328 NPI number — JOHN B LYMAN MD PC

Table of content: (NPI 1194903328)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194903328 NPI number — JOHN B LYMAN MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN B LYMAN MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
INTERMOUNTAIN EYE ASSOCIATES
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194903328
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
520 MEDICAL DR
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
BOUNTIFUL
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84010-4968
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-292-8878
Provider Business Mailing Address Fax Number:
801-292-5164

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
520 MEDICAL DR
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
BOUNTIFUL
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84010-4968
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-292-8878
Provider Business Practice Location Address Fax Number:
801-292-5164
Provider Enumeration Date:
02/11/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LYMAN
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
B
Authorized Official Title or Position:
DOCTOR/OWNER
Authorized Official Telephone Number:
801-292-8878

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  1656561205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1538189402 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 544500499008 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".




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