Mackey, Lisa Marie
Mackey, Lisa Marie is an individual health care provider with primary practice located at 3013 Winghaven Blvd , O Fallon MO 63368-3600. She recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as her primary health care specialty. Mackey, Lisa Marie can be contacted via phone (636) 561-3937.Contact Information
Primary practice address
3013 Winghaven Blvd
O Fallon MO 63368-3600
Phone: (636) 561-3937
Fax: (636) 561-4068
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | T03118 | Missouri |
Profile Details
| NPI number | 1982693297 |
|---|---|
| LBN Legal business name | Mackey, Lisa Marie |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 19th, 2005 |
| Last updated | Mar 30th, 2012 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1982693297 | NPPES |
| Missouri | MEDICAID | 318596913 | |
| Missouri | Other | 255611 | |
| Missouri | Other | 108397 |
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