Provider Demographics
NPI:1285416750
Name:KROELL, LISA MARIE (DO)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARIE
Last Name:KROELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:20 SOUTHBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLTON
Mailing Address - State:MA
Mailing Address - Zip Code:01507-5235
Mailing Address - Country:US
Mailing Address - Phone:508-765-5880
Mailing Address - Fax:508-434-0267
Practice Address - Street 1:20 SOUTHBRIDGE RD
Practice Address - Street 2:
Practice Address - City:CHARLTON
Practice Address - State:MA
Practice Address - Zip Code:01507-5235
Practice Address - Country:US
Practice Address - Phone:508-765-5880
Practice Address - Fax:508-434-0267
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4476156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician