MEDICARE: LISA J KOTT O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OEG000551	PA

General Provider Information

NPI Number	:	1447255765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA J KOTT O.D.

Provider Business Mailing Address
First Line	:	2108 HARRISBURG PIKE STE 100
Second Line	:
City	:	LANCASTER
State	:	PA
Zip	:	17601-2644
Country	:	US
Telephone Number	:	717-974-9661
Fax Number	:	717-974-9669

Provider Business Practice Location Address
First Line	:	2108 HARRISBURG PIKE
Second Line	:	STE 100
City	:	LANCASTER
State	:	PA
Zip	:	17601-2644
Country	:	US
Telephone Number	:	717-974-9661
Fax Number	:	717-974-9669

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	11/18/2022

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