Healthcare Provider Details

I. General information

NPI: 1831185099
Provider Name (Legal Business Name): ROBERT A LYTLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 05/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 MAIN ST
HYANNIS MA
02601-3109
US

IV. Provider business mailing address

51 MAIN ST
HYANNIS MA
02601-3109
US

V. Phone/Fax

Practice location:
  • Phone: 508-771-6447
  • Fax: 508-775-5104
Mailing address:
  • Phone: 508-771-6447
  • Fax: 508-775-5104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number54395
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: