Provider Demographics
NPI:1962019471
Name:LIZ VAWTER OD PA
Entity Type:Organization
Organization Name:LIZ VAWTER OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:KATHRYN
Authorized Official - Last Name:VAWTER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:941-224-9382
Mailing Address - Street 1:3811 2ND DR NE
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-5075
Mailing Address - Country:US
Mailing Address - Phone:941-224-9382
Mailing Address - Fax:
Practice Address - Street 1:2020 MANATEE AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-5856
Practice Address - Country:US
Practice Address - Phone:941-747-1831
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty