Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 046008741 | IL |
NPI | 1013055656 |
---|---|
Provider Name | Dr. Lisa Marie Politza-Termunde |
First Address | Orland Hills, IL 60487-5615 |
Second Address | Joliet, IL 60431-8303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2007 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U-74817 | (02) | IL |