Provider Demographics
NPI:1770574311
Name:SCHOLES, LISA M (OD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:M
Last Name:SCHOLES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:DIMARTILE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:1151 CORNWALL RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-7233
Mailing Address - Country:US
Mailing Address - Phone:717-272-4411
Mailing Address - Fax:717-272-8982
Practice Address - Street 1:1151 CORNWALL RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-7233
Practice Address - Country:US
Practice Address - Phone:717-272-4411
Practice Address - Fax:717-272-8982
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE007527T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC511600OtherHIGHMARK BLUE SHIELD
532131OtherAETNA
SC548576Medicare ID - Type Unspecified
PA0921350001Medicare NSC
SC511600OtherHIGHMARK BLUE SHIELD