Provider Demographics
NPI:1740348911
Name:CALVERT, LISA KAY (OD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:KAY
Last Name:CALVERT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:17144 SHERWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-2700
Mailing Address - Country:US
Mailing Address - Phone:402-851-0014
Mailing Address - Fax:
Practice Address - Street 1:5001 SERGEANT RD
Practice Address - Street 2:STE 45,
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-4774
Practice Address - Country:US
Practice Address - Phone:402-851-0014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1010152W00000X
IA1948152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEU32273Medicare UPIN