Individual
DR. LANCE CALL LYSIUK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
438 MAIN ST, SUITE 204, MIDDLETOWN, CT 06457-3396
(888) 964-6681
(888) 662-0859
Mailing address
888 WORCESTER ST, SUITE 130, WELLESLEY, MA 02482-3744
(617) 964-6681
(339) 686-2561
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
002499
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004189868
—
CT
01
—
090002499CT01
BLUE CROSS BLUE SHIELD
CT
01
—
410038928
MEDICARE RAILROAD
CT
Enumeration date
08/04/2006
Last updated
10/24/2014
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