Individual
DR. LISA FREDERICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
199077
AK
152W00000X
Optometrist
3574-TX
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1733721
—
AK
01
—
19068
SPECTERA
WA
01
—
2030FR
REGENCE
WA
01
—
49034
DAVIS
WA
01
—
510445794
TRIWEST
WA
01
—
WA-0928
NBN
WA
Enumeration date
10/02/2006
Last updated
04/13/2026
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