Healthcare Provider Details

I. General information

NPI: 1750491189
Provider Name (Legal Business Name): ARISTOTLE J LYSANDROU O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 RIVER HILL DR
ASHLAND KY
41101-7386
US

IV. Provider business mailing address

PO BOX 2113
HUNTINGTON WV
25721-2113
US

V. Phone/Fax

Practice location:
  • Phone: 606-329-2020
  • Fax: 606-329-2033
Mailing address:
  • Phone: 606-329-2020
  • Fax: 606-329-2033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1504DT
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: