Provider Demographics
NPI:1396807947
Name:DEPIETTO, LISA ANN
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:DEPIETTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ANN
Other - Last Name:MAY-DEPIETTO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:15118 MAIN ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-1653
Mailing Address - Country:US
Mailing Address - Phone:425-357-0508
Mailing Address - Fax:425-357-1082
Practice Address - Street 1:15118 MAIN ST
Practice Address - Street 2:SUITE 600
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-1653
Practice Address - Country:US
Practice Address - Phone:425-357-0508
Practice Address - Fax:425-357-1082
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00003878152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management