Provider Demographics
NPI:1467807933
Name:LEHR, ELISABETH ERIN (OD)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:ERIN
Last Name:LEHR
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ELISABETH
Other - Middle Name:ERIN
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:714 G ST
Mailing Address - Street 2:
Mailing Address - City:RUPERT
Mailing Address - State:ID
Mailing Address - Zip Code:83350-1612
Mailing Address - Country:US
Mailing Address - Phone:208-436-3455
Mailing Address - Fax:208-436-3815
Practice Address - Street 1:714 G ST
Practice Address - Street 2:
Practice Address - City:RUPERT
Practice Address - State:ID
Practice Address - Zip Code:83350-1612
Practice Address - Country:US
Practice Address - Phone:208-436-3455
Practice Address - Fax:208-436-3815
Is Sole Proprietor?:No
Enumeration Date:2016-05-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010983152W00000X
IDODP-100425152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist