Individual
DR. LEWIS E LISSES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1018 WYOMING AVE, WYOMING, PA 18644-1331
(570) 288-7471
(570) 288-8142
Mailing address
1018 WYOMING AVE, WYOMING, PA 18644-1331
(570) 288-7471
(570) 288-8142
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OEG000522
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1053382994
NPI INDIVIDUAL
PA
01
—
1891849063
NPI GROUP
PA
Enumeration date
01/30/2006
Last updated
07/02/2012
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