Individual provider Active NPI

Alexander Maxwell Lyss, OD

  • Optometrist
  • Saint Louis, MO
National Provider Identifier
1578300414
Registry record updated Sep 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2024024906 Issued in MO
Practice address
4901 Forest Park Ave
Dept Ophthalmology, 6TH FL
Saint Louis, MO 63108-1495
Phone
(314) 362-3937
Fax
(866) 505-8818
NPI assigned
Jul 9, 2024
Last updated
Sep 2, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2024024906 MO Primary

Addresses

Primary practice location

4901 Forest Park Ave
Dept Ophthalmology, 6TH FL
Saint Louis, MO 63108-1495

Mailing address

PO Box 7412011
Chicago, IL 60674-2011
Phone (314) 362-3937

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Washington University

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250918000219 MO Practitioner - Optometry 4385148881 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
University of Missouri St Louis - School of Optometry, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Washington UniversityGroup PAC ID 9830008770, 2,968 clinicians

Practice addresses (Care Compare)

4901 Forest Park Ave
FL 6
Saint Louis, MO 63108-1495
Phone (314) 362-3937

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Washington University CurrentSince Aug 1, 2025 Accepting new patients
Washington University CurrentSince Aug 1, 2025 Accepting new patients

Locations

1 Barnes Hospital Plz
Saint Louis, MO 63110
Phone (314) 362-9170

4901 Forest Park Ave
Fl 6
Saint Louis, MO 63108

660 S Euclid Ave
Saint Louis, MO 63110

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1720483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756771200000",
    "number": "1578300414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7412011",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606742011",
            "telephone_number": "314-362-3937",
            "fax_number": "866-505-8818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4901 FOREST PARK AVE",
            "address_2": "DEPT OPHTHALMOLOGY, 6TH FL",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631081495",
            "telephone_number": "314-362-3937",
            "fax_number": "866-505-8818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LYSS",
        "first_name": "ALEXANDER",
        "middle_name": "MAXWELL",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-07-09",
        "last_updated": "2025-09-02",
        "certification_date": "2025-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MO",
            "license": "2024024906",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "Y",
            "affiliationName": "Washington University",
            "address_1": "4901 Forest Park Ave",
            "address_2": "Dept Ophthalmology, 6th Fl",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631081495",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.