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General NPI Number Information
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NPI Number | 1760941488
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Entity Type | Organization
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Legal Business Name | LISA M. HAGGERTY, OPTOMETRIST
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Dates
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Enumeration Date | 03/13/2019
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Last Update Date | 03/13/2019
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Provider Practice Location Address
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Address Line | 220 ROUTE 6 AND 209
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City | MILFORD
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State | PA
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Zip | 18337-9454
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Country | US
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Telephone | 570-491-5334
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Fax | 570-491-5506
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Provider Business Mailing Address
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Address Line | 220 ROUTE 6 AND 209
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City | MILFORD
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State | PA
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Zip | 18337-9454
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Country | US
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Telephone | 570-491-5334
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Fax | 570-491-5506
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. LISA HAGGERTY
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Credential | OD
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Telephone | 570-491-5334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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