Provider Demographics
NPI:1578709200
Name:LISA MOFFITT INC
Entity Type:Organization
Organization Name:LISA MOFFITT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOFFITT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:814-724-3468
Mailing Address - Street 1:11605 HUNTERS RIDGE BLVD APT 5
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-6269
Mailing Address - Country:US
Mailing Address - Phone:814-724-3468
Mailing Address - Fax:
Practice Address - Street 1:16086 CONNEAUT LAKE RD
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-3884
Practice Address - Country:US
Practice Address - Phone:814-337-4426
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-30
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000769152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty