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General NPI Number Information
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NPI Number | 1356842538
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Entity Type | Organization
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Legal Business Name | LYLES EYE CENTER, PLLC
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Dates
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Enumeration Date | 02/23/2018
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Last Update Date | 02/23/2018
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Provider Practice Location Address
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Address Line | 140 COMMERCE BLVD
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City | BENTON
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State | KY
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Zip | 42025-1112
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Country | US
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Telephone | 270-252-3937
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Fax |
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Provider Business Mailing Address
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Address Line | 140 COMMERCE BLVD
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City | BENTON
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State | KY
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Zip | 42025-1112
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Country | US
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Telephone | 270-252-3937
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. NATASHA G LYLES
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Credential | OD
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Telephone | 270-252-3937
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1768DT
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License Number State | KY
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