Provider Demographics
NPI:1720565633
Name:OPFER, LISA HALL (RPSGT, RST)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:HALL
Last Name:OPFER
Suffix:
Gender:F
Credentials:RPSGT, RST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 AMSTERDAM DR
Mailing Address - Street 2:
Mailing Address - City:PELLA
Mailing Address - State:IA
Mailing Address - Zip Code:50219-7518
Mailing Address - Country:US
Mailing Address - Phone:515-321-0109
Mailing Address - Fax:515-321-0109
Practice Address - Street 1:142 AMSTERDAM DR
Practice Address - Street 2:
Practice Address - City:PELLA
Practice Address - State:IA
Practice Address - Zip Code:50219-7518
Practice Address - Country:US
Practice Address - Phone:515-321-0109
Practice Address - Fax:515-321-0109
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA008798156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist