Individual
LISA MOFFITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
16086 CONNEAUT LAKE RD, WALMART VISION CENTER, MEADVILLE, PA 16335-3884
(816) 337-4426
(814) 337-4320
Mailing address
30 TRINITY POINT DR, WALMART VISION CENTER, WASHINGTON, PA 15301-2974
(724) 229-7769
(724) 229-7792
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
PA0EG000769
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000027186
MEDICARE
PA
01
—
001746361 0003
PA DEPT OF HUMAN SERVICES
PA
01
—
0017463610003
PROMISE WELFARE
—
01
—
376852
BCBS
—
01
—
52269
DAVIS
—
Enumeration date
08/01/2006
Last updated
12/01/2016
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