Provider Demographics
NPI:1619956794
Name:TRAVEIS, LISA ANN (OD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:TRAVEIS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 MARKET STREET
Mailing Address - Street 2:STE. 100
Mailing Address - City:IPSWICH
Mailing Address - State:MA
Mailing Address - Zip Code:01938
Mailing Address - Country:US
Mailing Address - Phone:978-356-3015
Mailing Address - Fax:978-356-7525
Practice Address - Street 1:21 MARKET STREET
Practice Address - Street 2:STE. 100
Practice Address - City:IPSWICH
Practice Address - State:MA
Practice Address - Zip Code:01938
Practice Address - Country:US
Practice Address - Phone:978-356-3015
Practice Address - Fax:978-356-7525
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3308152W00000X
MAMA3308152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA732784OtherTUFTS ID #
MAT95898Medicare UPIN