Petersen, Lisa R

Petersen, Lisa R is an individual health care provider with primary practice located at 280 Exempla Cir , Lafayette CO 80026-3370. She recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as her primary health care specialty. Petersen, Lisa R can be contacted via phone (303) 338-4545.

Contact Information

Primary practice address
280 Exempla Cir Lafayette CO 80026-3370
Fax:
Website:

Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 2798 Colorado

Profile Details

NPI number 1982917209
LBN Legal business name Petersen, Lisa R
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 15th, 2010
Last updated Jun 23rd, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1982917209 NPPES
Colorado Other 022563 KAISER COMMERCIAL NUMBER
Colorado MEDICAID 21351058 KAISER COMMERCIAL NUMBER

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