Provider Demographics
NPI:1891849063
Name:LIS CORPORATION
Entity type:Organization
Organization Name:LIS CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LISSES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:570-288-7471
Mailing Address - Street 1:1018 WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:PA
Mailing Address - Zip Code:18644-1331
Mailing Address - Country:US
Mailing Address - Phone:570-288-7471
Mailing Address - Fax:570-288-8142
Practice Address - Street 1:1018 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:PA
Practice Address - Zip Code:18644-1331
Practice Address - Country:US
Practice Address - Phone:570-288-7471
Practice Address - Fax:570-288-8142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0896140001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1053382994OtherNPI INDIVIDUAL
PA1891849063OtherNPI GROUP
PA0896140001Medicare NSC