Provider Demographics
NPI:1063728889
Name:DOLEZEL, LISA LYNN
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:LYNN
Last Name:DOLEZEL
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:LYNN
Other - Last Name:LUND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 ASSOCIATE DR
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-2266
Mailing Address - Country:US
Mailing Address - Phone:607-433-6344
Mailing Address - Fax:607-433-6331
Practice Address - Street 1:1 ASSOCIATE DR
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-2266
Practice Address - Country:US
Practice Address - Phone:607-433-6344
Practice Address - Fax:607-433-6331
Is Sole Proprietor?:No
Enumeration Date:2010-08-31
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007233-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician