Provider Demographics
NPI:1801815246
Name:HAGER, LISA (OD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:HAGER
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 1:1 PARK PL
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-2965
Mailing Address - Country:US
Mailing Address - Phone:618-233-3040
Mailing Address - Fax:618-233-3739
Practice Address - Street 1:1 PARK PL
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-2965
Practice Address - Country:US
Practice Address - Phone:618-233-3040
Practice Address - Fax:618-233-3739
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-009861152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0814870031OtherMEDICARE NSC NUMBER
IL0814870023OtherMEDICARE NSC NUMBER
IL0814870008OtherMEDICARE NSC NUMBER
120175OtherHEALTH ALLIANCE
IL0814870029OtherMEDICARE NSC NUMBER
ILP00410559, CA2196OtherMEDICARE RAILROAD
ILP01665024OtherRAILROAD MEDICARE
IL2376OtherEYEMED
IL046009861Medicaid
IL0814870008OtherMEDICARE NSC NUMBER
IL0814870029OtherMEDICARE NSC NUMBER
IL0814870023OtherMEDICARE NSC NUMBER
ILP00410559, CA2196OtherMEDICARE RAILROAD
ILP01665024OtherRAILROAD MEDICARE
120175OtherHEALTH ALLIANCE