Provider Demographics
NPI:1497046403
Name:EARL H LIZOTTE, OD
Entity Type:Organization
Organization Name:EARL H LIZOTTE, OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EARL
Authorized Official - Middle Name:H
Authorized Official - Last Name:LIZOTTE
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:413-527-4881
Mailing Address - Street 1:176 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EASTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01027
Mailing Address - Country:US
Mailing Address - Phone:413-527-4881
Mailing Address - Fax:413-527-4892
Practice Address - Street 1:176 MAIN ST
Practice Address - Street 2:
Practice Address - City:EASTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01027
Practice Address - Country:US
Practice Address - Phone:413-527-4881
Practice Address - Fax:413-527-4892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-25
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA2057152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0309702Medicaid
MA0309702Medicaid
0740810001Medicare NSC
MA051758Medicare UPIN
MA051758Medicare Oscar/Certification