MEDICARE: LISA LANSINK 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	002454	IA

General Provider Information

NPI Number	:	1326277138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA LANSINK O.D.

Provider Business Mailing Address
First Line	:	4100 UNIVERSITY AVE
Second Line	:	#106
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-5956
Country	:	US
Telephone Number	:	515-224-1317
Fax Number	:	515-224-6069

Provider Business Practice Location Address
First Line	:	4100 UNIVERSITY AVE
Second Line	:	#106
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-5956
Country	:	US
Telephone Number	:	515-224-1317
Fax Number	:	515-224-6069

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

Provider Enumeration Date	:	07/14/2009
Last Update Date	:	10/05/2011

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