Provider Demographics
NPI:1013981638
Name:BROOKS, LISA R (OD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:R
Last Name:BROOKS
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:1134 SE MILL POND CT
Mailing Address - Street 2:VERACITY, PC
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50021
Mailing Address - Country:US
Mailing Address - Phone:515-964-0050
Mailing Address - Fax:515-255-8002
Practice Address - Street 1:119 N. ANKENY BLVD
Practice Address - Street 2:EYE MART OPTICAL
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023
Practice Address - Country:US
Practice Address - Phone:515-965-8858
Practice Address - Fax:515-965-7966
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2017-04-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA02210152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA45555OtherBLUE CROSS
IA0260315Medicaid
U87948Medicare UPIN
IAU87948Medicare UPIN
IA0260315Medicaid