Provider Demographics
NPI:1205824448
Name:HERRYGERS, LISA A (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:A
Last Name:HERRYGERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3820 N 27TH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-3234
Mailing Address - Country:US
Mailing Address - Phone:406-587-1245
Mailing Address - Fax:406-587-1092
Practice Address - Street 1:3820 N 27TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-3234
Practice Address - Country:US
Practice Address - Phone:406-587-1245
Practice Address - Fax:406-587-1092
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10344207WX0009X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0063835Medicaid
MT95055OtherBCBS
MT0063835Medicaid
H86499Medicare UPIN