Individual provider Active NPI

Stacy A Lyons, OD

  • Optometrist
  • Framingham, MA
National Provider Identifier
1962402644
Registry record updated Dec 28, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3440 Issued in MA
Practice address
31 Flagg Drive
New England Eye Fuller Middle School
Framingham, MA 01702
Phone
(508) 620-4956
Fax
(508) 879-4909
NPI assigned
Jul 26, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 3440 MA Primary

Addresses

Primary practice location

31 Flagg Drive
New England Eye Fuller Middle School
Framingham, MA 01702

Mailing address

930 Common Wealth Ave Suite 2a
New England Eye Institue
Boston, MA 02215
Phone (617) 262-2020

Other identifiers 1

IdentifierTypeStateIssuer
324370MedicaidMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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
I20040823000575 MA Practitioner - Optometry 3870567217 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
New England College of Optometry, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Charles River Community Health, IncGroup PAC ID 5294709812, 33 clinicians

Practice addresses (Care Compare)

43 Foundry Ave
Suite 110
Waltham, MA 02453-8313
Phone (781) 693-3800

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3440MAMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Charles River Community Health Inc CurrentSince May 20, 2017 Accepting new patients
Charles River Community Health, Inc CurrentSince May 20, 2017 Accepting new patients

Locations

495 Western Ave
Brighton, MA 02135

43 Foundry Ave
Ste 110
Waltham, MA 02453
Phone (781) 693-3800

Interoperability endpoints

  • Direct secure messaging: slyons20001@direct.ctc.masshiway.net

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1122336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1198800000000",
    "number": "1962402644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "930 COMMON WEALTH AVE SUITE 2A",
            "address_2": "NEW ENGLAND EYE INSTITUE",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "02215",
            "telephone_number": "617-262-2020",
            "fax_number": "617-236-6323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31 FLAGG DRIVE",
            "address_2": "NEW ENGLAND EYE FULLER MIDDLE SCHOOL",
            "city": "FRAMINGHAM",
            "state": "MA",
            "postal_code": "01702",
            "telephone_number": "508-620-4956",
            "fax_number": "508-879-4909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LYONS",
        "first_name": "STACY",
        "middle_name": "A",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-26",
        "last_updated": "2007-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MA",
            "license": "3440",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "324370",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Framingham, MA

Sources for this page

Verify at the official NPI Registry.