MEDICARE: DR. LISA ANDERSON 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	0618000206	VA
2	152W00000X	Optometrist	DA1065	MD

General Provider Information

NPI Number	:	1952303042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA ANDERSON O.D.

Provider Business Mailing Address
First Line	:	9909 GEORGETOWN PIKE
Second Line	:
City	:	GREAT FALLS
State	:	VA
Zip	:	22066-2826
Country	:	US
Telephone Number	:	703-759-0061
Fax Number	:

Provider Business Practice Location Address
First Line	:	9909 GEORGETOWN PIKE
Second Line	:
City	:	GREAT FALLS
State	:	VA
Zip	:	22066-2826
Country	:	US
Telephone Number	:	703-759-0061
Fax Number	:	703-759-0063

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

Provider Enumeration Date	:	06/02/2005
Last Update Date	:	12/03/2010

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