1750384863 NPI number — DR. LISA M MCDEVITT O.D.

Table of content: DR. LISA M MCDEVITT O.D. (NPI 1750384863)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750384863 NPI number — DR. LISA M MCDEVITT O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCDEVITT
Provider First Name:
LISA
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

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:
1750384863
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/30/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 N KENHORST BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
READING
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19607-1535
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-796-1300
Provider Business Mailing Address Fax Number:
610-796-1913

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 N KENHORST BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
READING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19607-1535
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-796-1300
Provider Business Practice Location Address Fax Number:
610-796-1913
Provider Enumeration Date:
05/23/2005

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:  OEG000047 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0202284000 . This is a "INDEPENDENCE BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 410034065 . This is a "RAILROAD MEDICARE 24K#" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6762464 . This is a "CIGNA HEALTH CARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: PA06980 . This is a "VBA ACCOUNT #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0000175234 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 113714 . This is a "GEISINGER HEALTH SYSTEM" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 4650262 . This is a "AETNA HEALTH INC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 339637 . This is a "ADVANTRA FREEDOM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01689801 . This is a "CAPITAL BLUE CROSS 24K #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 02631700 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 339637 . This is a "HEALTHAMERICA/ASSURANCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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