1003875204 NPI number — DR. EARL H LIZOTTE JR. OD

Table of content: DR. EARL H LIZOTTE JR. OD (NPI 1003875204)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003875204 NPI number — DR. EARL H LIZOTTE JR. OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIZOTTE
Provider First Name:
EARL
Provider Middle Name:
H
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
OD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003875204
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
176 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EASTHAMPTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-527-4881
Provider Business Mailing Address Fax Number:
413-527-4892

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
176 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EASTHAMPTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-527-4881
Provider Business Practice Location Address Fax Number:
413-527-4892
Provider Enumeration Date:
03/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  2057 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: MA2057 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7262815004 . This is a "CIGNA HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: W15085 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 782883 . This is a "CONNECTICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000024532 . This is a "BMC HEALTH NET PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 00000314701 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0309702 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 042349836 . This is a "CIGNA HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 799324 . This is a "TUFTS HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 18888 . This is a "SPECTERA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 967179 . This is a "NETWORK HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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