Provider Demographics
NPI:1720044563
Name:ZARWELL, LISA S (OD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:S
Last Name:ZARWELL
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 1:1025 REGENT ST
Mailing Address - Street 2:DAVIS DUEHR DEAN DEAN MEDICAL CENTER
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-1248
Mailing Address - Country:US
Mailing Address - Phone:608-282-2000
Mailing Address - Fax:608-282-2172
Practice Address - Street 1:1025 REGENT ST
Practice Address - Street 2:DAVIS DUEHR DEAN DEAN MEDICAL CENTER
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1248
Practice Address - Country:US
Practice Address - Phone:608-282-2000
Practice Address - Fax:608-282-2172
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2829-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI60479OtherDEAN HEALTH INSURANCE
WI2016800OtherPHYSICIANS PLUS
WI38612000Medicaid
WI037574150Medicare PIN
WIP00340821Medicare PIN
V01768Medicare UPIN
WI38612000Medicaid
WI093674150Medicare PIN
WIP00364694Medicare PIN