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Individual

DR. LISA THATCH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
O.D.

Contact information

Practice address
2698 GRAVOIS RD, HIGH RIDGE, MO 63049-2508
(636) 677-1166
(636) 677-1324
Mailing address
2698 GRAVOIS RD, HIGH RIDGE, MO 63049-2508
(636) 677-1166
(636) 677-1324

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
046-009535
IL
152W00000X
Optometrist
Primary
2003014792
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
046009535
IL
01
0814870010
MEDICARE NSC NUMBER
IL
01
0814870023
MEDICARE NSC NUMBER
IL
01
0814870026
MEDICARE NSC NUMBER
IL
01
087817
HEALTH ALLIANCE
01
252039
HARMONY HEALTH PLAN
01
IL9535
EYEMED
01
P00040122
MEDICARE RAILROAD
IL
Enumeration date
05/12/2006
Last updated
04/12/2019
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