Individual
MR. EDWARD JOSEPH LYDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
C.O.
Contact information
Practice address
712 FIRST STREET, FAIRFIELD, CA 94533-4746
(707) 428-3800
(707) 428-1444
Mailing address
712 FIRST STREET, FAIRFIELD, CA 94533-4746
(707) 428-3800
(707) 428-1444
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
Primary
CO1167
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
XA0011670
—
CA
01
—
ZZZ85255Z
BLUE SHIELD/BLUE CROSS
CA
Enumeration date
08/10/2006
Last updated
07/08/2007
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