Provider Demographics
NPI:1982848552
Name:BURNS, LISA TERRI
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:TERRI
Last Name:BURNS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1294 UPPER LENOX AVE
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:NY
Mailing Address - Zip Code:13421-2681
Mailing Address - Country:US
Mailing Address - Phone:315-361-4050
Mailing Address - Fax:315-361-1933
Practice Address - Street 1:1294 UPPER LENOX AVE
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:NY
Practice Address - Zip Code:13421-2681
Practice Address - Country:US
Practice Address - Phone:315-361-4050
Practice Address - Fax:315-361-1933
Is Sole Proprietor?:No
Enumeration Date:2009-04-27
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY008228156FX1202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1202XEye and Vision Services ProvidersTechnician/TechnologistOptometric Technician