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NPI Code Detail

MEDICARE: DR. ALBERT JAMES LYDAY JR. O.D.

MEDICARE: DR. ALBERT JAMES LYDAY JR. 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
1152W00000XOptometrist475SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
24489641OTHERSCAETNA PROVIDER NUMBER
38344107002OTHERSCCIGNA PROVIDER NUMBER

General Provider Information

NPI Number : 1669442240
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ALBERT JAMES LYDAY JR. O.D.
Provider Business Mailing Address
First Line : 220 S PENDLETON ST
Second Line :
City : EASLEY
State : SC
Zip : 29640-3048
Country : US
Telephone Number : 864-859-3233
Fax Number : 864-850-4001
Provider Business Practice Location Address
First Line : 601 HALTON RD
Second Line :
City : GREENVILLE
State : SC
Zip : 29607-3403
Country : US
Telephone Number : 864-458-7956
Fax Number : 864-458-8390
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/25/2006
Last Update Date : 10/22/2007

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