1568586337 NPI number — DR. LISA BISSESSAR O.D

Table of content: DR. LISA BISSESSAR O.D (NPI 1568586337)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568586337 NPI number — DR. LISA BISSESSAR O.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BISSESSAR
Provider First Name:
LISA
Provider Middle Name:
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:
1568586337
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3402 TECHNOLOGICAL AVE
Provider Second Line Business Mailing Address:
SUITE 124
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32817-1402
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-208-1890
Provider Business Mailing Address Fax Number:
407-208-1877

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3402 TECHNOLOGICAL AVE
Provider Second Line Business Practice Location Address:
SUITE 124
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32817-1402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-208-1890
Provider Business Practice Location Address Fax Number:
407-208-1877
Provider Enumeration Date:
03/19/2007

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:  OPC3871 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 16919 . This is a "AVESIS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2001559460 . This is a "WELLCARE HMO" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 09298 . This is a "MEDICAL EYE SERVICES" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 201559450 . This is a "ADVANTICA EYE CARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 201559460 . This is a "CITRUS MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 201559460 . This is a "SUPERIOR VISION" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 59396 . This is a "SAFEGUARD PPO" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 201559460 . This is a "CITRUS HEALTH CARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 201559460 . This is a "GREAT WEST" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 201559460 . This is a "PREFERRED ONE ADMIN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 222104 . This is a "COLE VISION" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 24570 . This is a "SPECTERA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 44732 . This is a "DAVIS VISION" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 13734 . This is a "SVS FORD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 921486 . This is a "BLOCK VISION" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 201559460 . This is a "STAYWELL HEALTHY KIDS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 100724 . This is a "NVA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 201559460 . This is a "ALLIED EYE CARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 201559460 . This is a "CARE ONE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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