Provider Demographics
NPI:1750384863
Name:MCDEVITT, LISA M (OD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:M
Last Name:MCDEVITT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:201 N KENHORST BLVD
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19607-1535
Mailing Address - Country:US
Mailing Address - Phone:610-796-1300
Mailing Address - Fax:610-796-1913
Practice Address - Street 1:201 N KENHORST BLVD
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19607-1535
Practice Address - Country:US
Practice Address - Phone:610-796-1300
Practice Address - Fax:610-796-1913
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOEG000047152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0202284000OtherINDEPENDENCE BLUE CROSS
410034065OtherRAILROAD MEDICARE 24K#
PA6762464OtherCIGNA HEALTH CARE
PAPA06980OtherVBA ACCOUNT #
PA0000175234OtherHIGHMARK BLUE SHIELD
PA113714OtherGEISINGER HEALTH SYSTEM
PA4650262OtherAETNA HEALTH INC
339637OtherADVANTRA FREEDOM
PA01689801OtherCAPITAL BLUE CROSS 24K #
PA02631700OtherCAPITAL BLUE CROSS
PA339637OtherHEALTHAMERICA/ASSURANCE
PA02631700OtherCAPITAL BLUE CROSS
PA6762464OtherCIGNA HEALTH CARE