Provider Demographics
NPI:1538189402
Name:LYMAN, JOHN B (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:B
Last Name:LYMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 MEDICAL DR.
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-8930
Mailing Address - Country:US
Mailing Address - Phone:801-292-8878
Mailing Address - Fax:801-292-5164
Practice Address - Street 1:520 MEDICAL DR.
Practice Address - Street 2:SUITE 201
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-8930
Practice Address - Country:US
Practice Address - Phone:801-292-8878
Practice Address - Fax:801-292-5164
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT1656561205207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT00001354Medicare ID - Type Unspecified
UTC93190Medicare UPIN