Provider Demographics
NPI:1467995910
Name:LHERISSON, LOURDES E (OD)
Entity Type:Individual
Prefix:MS
First Name:LOURDES
Middle Name:E
Last Name:LHERISSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:651 KAPKOWSKI ROAD
Mailing Address - Street 2:STE. 1236
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07201
Mailing Address - Country:US
Mailing Address - Phone:908-354-1599
Mailing Address - Fax:908-354-1344
Practice Address - Street 1:651 KAPKOWSKI RD.
Practice Address - Street 2:STE. 1236
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07201
Practice Address - Country:US
Practice Address - Phone:908-354-1599
Practice Address - Fax:908-354-1344
Is Sole Proprietor?:No
Enumeration Date:2016-11-30
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ270A00669800152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist