Provider Demographics
NPI:1740366194
Name:LILLIE, JULIE ELLEN (OD)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:ELLEN
Last Name:LILLIE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:JULIE
Other - Middle Name:ELLEN
Other - Last Name:BEUERIDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2576 WEST 8TH STREET
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-4416
Mailing Address - Country:US
Mailing Address - Phone:814-833-1194
Mailing Address - Fax:814-838-9530
Practice Address - Street 1:2576 WEST 8TH STREET
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-4416
Practice Address - Country:US
Practice Address - Phone:814-833-1194
Practice Address - Fax:814-838-9530
Is Sole Proprietor?:No
Enumeration Date:2006-10-28
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADEG000215152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPA0215OtherEYEMED
PA0015585300004Medicaid
PA3451OtherUNISON
PA3451OtherDAVIS VISION
PAWE1350395OtherBCBS
PA393477OtherNATIONAL VISION ADMIN
PA53180OtherDAVIS VISION
PA13008OtherSPECTERA
PAPA7516OtherVISION BENEFITS OF AMERIC
PAPA0215OtherEYEMED
PA3451OtherUNISON