MEDICARE: DR. LISA R. KEISER 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	OEG001065	PA

General Provider Information

NPI Number	:	1023090529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA R. KEISER O.D.

Provider Business Mailing Address
First Line	:	503 HIGH ST
Second Line	:
City	:	WATERFORD
State	:	PA
Zip	:	16441-9750
Country	:	US
Telephone Number	:	814-796-1133
Fax Number	:	814-796-1133

Provider Business Practice Location Address
First Line	:	503 HIGH ST
Second Line	:
City	:	WATERFORD
State	:	PA
Zip	:	16441-9750
Country	:	US
Telephone Number	:	814-796-1133
Fax Number	:	814-796-1133

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

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	07/08/2007

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