Provider Demographics
NPI:1801359146
Name:PFLEGER, LISA R (OPTICIAN)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:R
Last Name:PFLEGER
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:R
Other - Last Name:KEYSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OPTICIAN
Mailing Address - Street 1:4 SPRINGVILLE RD STE A
Mailing Address - Street 2:
Mailing Address - City:HAMPTON BAYS
Mailing Address - State:NY
Mailing Address - Zip Code:11946-2290
Mailing Address - Country:US
Mailing Address - Phone:631-875-4544
Mailing Address - Fax:
Practice Address - Street 1:4 SPRINGVILLE RD STE A
Practice Address - Street 2:
Practice Address - City:HAMPTON BAYS
Practice Address - State:NY
Practice Address - Zip Code:11946-2290
Practice Address - Country:US
Practice Address - Phone:631-875-4544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-12
Last Update Date:2021-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC007812-1156FC0801X, 156FX1800X
156FX1202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
No156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens Fitter
No156FX1202XEye and Vision Services ProvidersTechnician/TechnologistOptometric TechnicianGroup - Multi-Specialty