Provider Demographics
NPI:1245329994
Name:BURSETT, LISA ZAID (OD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:ZAID
Last Name:BURSETT
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 1:2323 EASTLAKE AVE E # 401
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-3305
Mailing Address - Country:US
Mailing Address - Phone:206-632-2237
Mailing Address - Fax:206-632-3811
Practice Address - Street 1:2323 EASTLAKE AVE E # 401
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-3305
Practice Address - Country:US
Practice Address - Phone:206-632-2237
Practice Address - Fax:206-632-3811
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3337152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU77197Medicare UPIN
WAAB11477Medicare ID - Type Unspecified