Active NPI
Aristotle J Lysandrou, O.D.
- Optometrist
- Ashland, KY
National Provider Identifier
1750491189
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1504DT
- Practice address
- 451 River Hill Dr
Ashland, KY 41101-7386 - Phone
- (606) 329-2020
- Fax
- (606) 329-2033
- NPI assigned
- Aug 30, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1504DT | KY | Primary |
Addresses
Primary practice location
451 River Hill Dr
Ashland, KY 41101-7386
Mailing address
PO Box 2113
Huntington, WV 25721-2113
Phone (606) 329-2020
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 27039 | Other | KY | SPECTERA |
| 77001329 | Medicaid | KY | |
| 52141 | Other | KY | DAVIS VISION |
| 000000317201 | Other | KY | ANTHEM BC/BS |
| LY1728649 | Other | KY | CLARITY VISION |
| LY1728649 | Other | KY | OPTICHOICE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040130000027 | OH | Practitioner - Optometry | 1759284482 | Practice locations: Southpoint, OH |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4299 | OH | MD | Rehabilitation Chiropractor |
| 1504DT | KY | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wal-Mart Stores East, LP | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1750491189",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2113",
"city": "HUNTINGTON",
"state": "WV",
"postal_code": "257212113",
"telephone_number": "606-329-2020",
"fax_number": "606-329-2033"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "451 RIVER HILL DR",
"city": "ASHLAND",
"state": "KY",
"postal_code": "411017386",
"telephone_number": "606-329-2020",
"fax_number": "606-329-2033"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LYSANDROU",
"first_name": "ARISTOTLE",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "KY",
"license": "1504DT",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SPECTERA",
"identifier": "27039",
"state": "KY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "77001329",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DAVIS VISION",
"identifier": "52141",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BC/BS",
"identifier": "000000317201",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CLARITY VISION",
"identifier": "LY1728649",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OPTICHOICE",
"identifier": "LY1728649",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ashland, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.