Provider Demographics
NPI:1144532953
Name:MEDINA, LYDIA CAROLYN (OD)
Entity type:Individual
Prefix:DR
First Name:LYDIA
Middle Name:CAROLYN
Last Name:MEDINA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:METRO OFFICE PARK # 3
Mailing Address - Street 2:SUITE 108 PMB 206
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00968-1704
Mailing Address - Country:US
Mailing Address - Phone:939-218-1157
Mailing Address - Fax:
Practice Address - Street 1:METRO OFFICE PARK # 3
Practice Address - Street 2:SUITE 108 PMB 206
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968-1704
Practice Address - Country:US
Practice Address - Phone:939-218-1157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-08
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR444152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist