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NPI Code Detail

MEDICARE: DR. LISA RENEE CANTRELL O.D.

MEDICARE:  DR. LISA RENEE CANTRELL  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
1152W00000XOptometrist6924TGTX

General Provider Information

NPI Number : 1245240688
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LISA RENEE CANTRELL O.D.
Provider Business Mailing Address
First Line : 8614 WESTWOOD CENTER DR FL 9
Second Line :
City : VIENNA
State : VA
Zip : 22182-2442
Country : US
Telephone Number : 703-847-8899
Fax Number : 571-223-6780
Provider Business Practice Location Address
First Line : 433 SPORTSPLEX DR STE 100
Second Line :
City : DRIPPING SPRINGS
State : TX
Zip : 78620-5359
Country : US
Telephone Number : 512-858-0020
Fax Number : 512-858-2720
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2006
Last Update Date : 06/25/2024

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Directions to “ DR. LISA RENEE CANTRELL O.D.” Practice Location

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