Provider Demographics
NPI:1275564999
Name:O'BRIEN, LISA ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:ANN
Last Name:O'BRIEN
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 1:3408 OLSEN BLVD
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-3017
Mailing Address - Country:US
Mailing Address - Phone:806-355-5633
Mailing Address - Fax:806-355-9133
Practice Address - Street 1:3408 OLSEN BLVD
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-3017
Practice Address - Country:US
Practice Address - Phone:806-355-5633
Practice Address - Fax:806-355-9133
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5815TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120621100OtherFIRSTCARE/SOUTHWEST
TX80240QOtherBCBS
TX80240QOtherBCBS
TXU77612Medicare UPIN