Provider Demographics
NPI:1942826011
Name:VAN LANDEGEM, LISELOTTE LORE (OD)
Entity Type:Individual
Prefix:DR
First Name:LISELOTTE
Middle Name:LORE
Last Name:VAN LANDEGEM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:LISELOTTE
Other - Middle Name:LORE
Other - Last Name:VAN LANDEGEM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:27OA00708400
Mailing Address - Street 1:127 NEWARK AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-5862
Mailing Address - Country:US
Mailing Address - Phone:120-133-3276
Mailing Address - Fax:
Practice Address - Street 1:127 NEWARK AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-5862
Practice Address - Country:US
Practice Address - Phone:201-333-2768
Practice Address - Fax:201-333-3145
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV009138152W00000X
NJ27OA00708400152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist