Lydon'S Orthotic Service

Primary specialty

OrthotistTaxonomy code 222Z00000X

License

CO1167

Legal business name

LYDON'S ORTHOTIC SERVICE

Practice address

1200 Western Street
Suite B
Fairfield, CA 94533-2474

Phone

(707) 428-1705

Fax

(707) 428-1733

NPI assigned

Aug 14, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Edward Joseph Lydon, C.O.

Title

Owner

Phone

(707) 428-1705

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1155513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1861405516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 WESTERN STREET",
            "address_2": "SUITE B",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945332474",
            "telephone_number": "707-428-1705",
            "fax_number": "707-428-1733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 WESTERN STREET",
            "address_2": "SUITE B",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945332474",
            "telephone_number": "707-428-1705",
            "fax_number": "707-428-1733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LYDON'S ORTHOTIC SERVICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LYDON",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "707-428-1705",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "C.O."
    },
    "taxonomies": [
        {
            "code": "222Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthotist",
            "state": null,
            "license": "CO1167",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "XA0011670",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD/BLUE CROSS",
            "identifier": "ZZZ66766Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Luxottica of America Inc.
• Luxottica Retail North America Inc
• Jasmine Kim Crispino Ly, MSW
• Stephanie Anh Ly
• Edward Joseph Lydon, C.O.
• Stephanie Kaiklian Lynch
• Travis Lynds
• Debra Lyons
• Vinh Ma, LMFT
• Ma'S Helping Hands Doula Services

• Orthotist in Fairfield, CA
• Providers in Fairfield, CA by specialty
• Orthotist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.