=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497046403
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EARL H LIZOTTE, OD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/25/2011
-----------------------------------------------------
Last Update Date | 12/14/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 176 MAIN ST
-----------------------------------------------------
City | EASTHAMPTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-527-4881
-----------------------------------------------------
Fax | 413-527-4892
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 176 MAIN ST
-----------------------------------------------------
City | EASTHAMPTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-527-4881
-----------------------------------------------------
Fax | 413-527-4892
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | EARL H LIZOTTE JR.
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 413-527-4881
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | MA2057
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------