Individual
DR. LISA L. PORTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
1480 E LINCOLN RD STE B, IDAHO FALLS, ID 83401-2128
(208) 525-8686
(208) 525-8684
Mailing address
852 E PARRI DR, IDAHO FALLS, ID 83401-5626
(208) 757-0441
(208) 656-7713
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP-10013
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000807525000
—
ID
Enumeration date
07/11/2006
Last updated
11/11/2011
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