Healthcare Provider Details

I. General information

NPI: 1831470350
Provider Name (Legal Business Name): JENNIFER LYERLY OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2011
Last Update Date: 08/31/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 LOWER SHILOH WAY STE 105
MORRISVILLE NC
27560-5431
US

IV. Provider business mailing address

1004 LOWER SHILOH WAY STE 105
MORRISVILLE NC
27560-5431
US

V. Phone/Fax

Practice location:
  • Phone: 919-472-4070
  • Fax: 919-472-4070
Mailing address:
  • Phone: 919-472-4070
  • Fax: 919-472-4070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2241
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: