Provider Demographics
NPI:1023090529
Name:KEISER, LISA R (OD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:R
Last Name:KEISER
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 1:503 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16441-9750
Mailing Address - Country:US
Mailing Address - Phone:814-796-1133
Mailing Address - Fax:814-796-1133
Practice Address - Street 1:503 HIGH ST
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:PA
Practice Address - Zip Code:16441-9750
Practice Address - Country:US
Practice Address - Phone:814-796-1133
Practice Address - Fax:814-796-1133
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001065152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA051156Medicare ID - Type Unspecified
PAU37060Medicare UPIN