Provider Demographics
NPI:1659457448
Name:DRYIER, LISA A (OD)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:A
Last Name:DRYIER
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 1:623 E BOUGHTON RD STE 120
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-2694
Mailing Address - Country:US
Mailing Address - Phone:630-783-1514
Mailing Address - Fax:
Practice Address - Street 1:623 E BOUGHTON RD STE 120
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-2694
Practice Address - Country:US
Practice Address - Phone:630-783-1514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2012-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009236152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist