Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | TO 2357 | MO |
NPI | 1114056231 |
---|---|
Provider Name | Dr. Kevin Greeley Lydon |
First Address | Saint Peters, MO 63376-1505 |
Second Address | Saint Peters, MO 63376-1505 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2007 |
Last Update Date | 12/08/2009 |