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Individual

LISA DOUGLASS LYSTAD

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
23250 CHAGRIN BLVD, BLD 5 STE 440, BEACHWOOD, OH 44122
(216) 514-1864
(216) 514-1867
Mailing address
23250 CHAGRIN BLVD #5, BLDG #5 SUITE 440, BEACHWOOD, OH 44122
(216) 514-1864
(216) 514-1867

Taxonomy

Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
35061509L
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0884593
OH
Enumeration date
01/27/2006
Last updated
07/08/2007
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