Provider Demographics
NPI:1952303042
Name:ANDERSON, LISA (OD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:ANDERSON
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 1:9909 GEORGETOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:22066-2826
Mailing Address - Country:US
Mailing Address - Phone:703-759-0061
Mailing Address - Fax:
Practice Address - Street 1:9909 GEORGETOWN PIKE
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:VA
Practice Address - Zip Code:22066-2826
Practice Address - Country:US
Practice Address - Phone:703-759-0061
Practice Address - Fax:703-759-0063
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000206152W00000X
MDDA1065152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist