Provider Demographics
NPI:1336136811
Name:MARQUES, LISA A (OD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:MARQUES
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 1:51 STATE RD
Mailing Address - Street 2:
Mailing Address - City:N DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-3319
Mailing Address - Country:US
Mailing Address - Phone:508-994-1400
Mailing Address - Fax:508-910-2228
Practice Address - Street 1:1741 PRESIDENT AVE
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-7113
Practice Address - Country:US
Practice Address - Phone:508-674-2020
Practice Address - Fax:508-674-0359
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3736152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0300292Medicaid
MA410026305Medicare PIN
MA0300292Medicaid
MA460458Medicare PIN