Provider Demographics
NPI:1417250374
Name:LISA E NADEL OD PA
Entity Type:Organization
Organization Name:LISA E NADEL OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:NADEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-426-4944
Mailing Address - Street 1:6518 N STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-3623
Mailing Address - Country:US
Mailing Address - Phone:954-426-4944
Mailing Address - Fax:954-426-3109
Practice Address - Street 1:6518 N STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-3623
Practice Address - Country:US
Practice Address - Phone:954-426-4944
Practice Address - Fax:954-426-3109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-15
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2624152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B4T9FOtherFLORIDA BLUE
FL0788220001Medicare NSC
B4T9FOtherFLORIDA BLUE
FLU40262Medicare UPIN
FL20407Medicare PIN