Healthcare Provider Details

I. General information

NPI: 1801457833
Provider Name (Legal Business Name): RACHAEL RAY LYON LYERLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2019
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2715 DAMON ST
EAU CLAIRE WI
54701-3899
US

IV. Provider business mailing address

2715 DAMON ST
EAU CLAIRE WI
54701-3899
US

V. Phone/Fax

Practice location:
  • Phone: 715-834-8471
  • Fax:
Mailing address:
  • Phone: 715-834-8471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number82348-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: