MEDICARE: DR. TED R LYMER II O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	T02693	MO
2	152W00000X	Optometrist	OPT.0003021	CO

General Provider Information

NPI Number	:	1528378411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TED R LYMER II O.D.

Provider Business Mailing Address
First Line	:	1710 BRIARGATE BLVD STE 485
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-3461
Country	:	US
Telephone Number	:	719-266-8473
Fax Number	:	719-266-9443

Provider Business Practice Location Address
First Line	:	9362 GRAND CORDERA PKWY STE 110
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80924-7007
Country	:	US
Telephone Number	:	719-888-4688
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2010
Last Update Date	:	08/18/2020

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