Provider Demographics
NPI:1740696749
Name:DRAPER, LISA (OD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:DRAPER
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 1:5301 LIMESTONE RD
Mailing Address - Street 2:SUITE 128
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-1250
Mailing Address - Country:US
Mailing Address - Phone:302-239-1933
Mailing Address - Fax:302-489-0130
Practice Address - Street 1:1430 HARRISBURG PIKE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2615
Practice Address - Country:US
Practice Address - Phone:717-606-1150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-10
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8488T152W00000X
DEI3-0001385152W00000X
PAOEG003959152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1124091-04Medicaid
TX00E63GMedicare PIN