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NPI Code Detail

MEDICARE: DR. LISA JEANETTE HIGSON O.D.

MEDICARE: DR. LISA JEANETTE HIGSON 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
1152W00000XOptometrist14141CA

General Provider Information

NPI Number : 1528355849
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LISA JEANETTE HIGSON O.D.
Provider Business Mailing Address
First Line : 330 CRAMPTON ST
Second Line :
City : RENO
State : NV
Zip : 89502-2480
Country : US
Telephone Number : 775-786-7200
Fax Number :
Provider Business Practice Location Address
First Line : 330 CRAMPTON ST
Second Line :
City : RENO
State : NV
Zip : 89502-2480
Country : US
Telephone Number : 775-786-7200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2011
Last Update Date : 09/27/2011

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