Provider Demographics
NPI:1417463902
Name:CARTIER, LISA (LICENSED OPTICIAN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:CARTIER
Suffix:
Gender:F
Credentials:LICENSED OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3222 STATE ROUTE 11
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953-4709
Mailing Address - Country:US
Mailing Address - Phone:518-483-8936
Mailing Address - Fax:518-483-8972
Practice Address - Street 1:3222 STATE ROUTE 11
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-4709
Practice Address - Country:US
Practice Address - Phone:518-483-8936
Practice Address - Fax:518-483-8972
Is Sole Proprietor?:No
Enumeration Date:2017-12-19
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009243-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician