Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 02189 | IA |
NPI | 1225094881 |
---|---|
Provider Name | Dr. Lisa Anne Nix |
First Address | Eldridge, IA 52748-2023 |
Second Address | Le Claire, IA 52753-9236 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2006 |
Last Update Date | 19/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0223669 | (05) | IA |
AO1823 | (02) | IA |