Provider Demographics
NPI:1356677975
Name:LISA BADOWSKI OD MS FAAO PC
Entity Type:Organization
Organization Name:LISA BADOWSKI OD MS FAAO PC
Other - Org Name:HEALTHY VISION EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BADOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:OD, MS, FAAO
Authorized Official - Phone:614-668-7418
Mailing Address - Street 1:2760 OVERLOOK DR
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-6750
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14200 E ALAMEDA AVE
Practice Address - Street 2:JC PENNEY OPTICAL
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-2511
Practice Address - Country:US
Practice Address - Phone:303-344-1272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-02
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO2407152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty