Provider Demographics
NPI:1124024302
Name:HOWARD, LISA SANFORD (OD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:SANFORD
Last Name:HOWARD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 979
Mailing Address - Street 2:
Mailing Address - City:MIDDLESBORO
Mailing Address - State:KY
Mailing Address - Zip Code:40965-0979
Mailing Address - Country:US
Mailing Address - Phone:606-248-2549
Mailing Address - Fax:606-248-9188
Practice Address - Street 1:1403 CUMBERLAND AVE
Practice Address - Street 2:STE A
Practice Address - City:MIDDLESBORO
Practice Address - State:KY
Practice Address - Zip Code:40965-1158
Practice Address - Country:US
Practice Address - Phone:606-248-2549
Practice Address - Fax:606-248-9188
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1082 DT152W00000X
KY1082DT152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy