Individual
DR. LYLE SHELDON THORSTENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M. D.
Contact information
Practice address
4500 S LANCASTER RD STE 112C, DALLAS, TX 75216-7167
(214) 857-1441
Mailing address
PO BOX 845347, DALLAS, TX 75284-5347
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
F2064
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
033864201
—
TX
05
—
033864202
—
TX
01
—
8F2997
MEDICARE
TX
01
—
HH69
BLUE CROSS BLUE SHIELD
TX
05
—
P000HH693
—
TX
Enumeration date
07/08/2005
Last updated
07/10/2014
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