Provider Demographics
NPI:1548559446
Name:CLOSE, LISANNE (OD)
Entity Type:Individual
Prefix:DR
First Name:LISANNE
Middle Name:
Last Name:CLOSE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:LISANNE
Other - Middle Name:
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:875 N MILWAUKEE AVE UNIT 300
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-3167
Practice Address - Country:US
Practice Address - Phone:847-325-4440
Practice Address - Fax:847-325-4443
Is Sole Proprietor?:No
Enumeration Date:2011-03-31
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046008884152W00000X
IL046-008884152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist