Thatch, Lisa

Thatch, Lisa is an individual health care provider with primary practice located at 2698 Gravois Rd , High Ridge MO 63049-2508. She recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as her primary health care specialty. Thatch, Lisa can be contacted via phone (636) 677-1166.

Contact Information

Primary practice address
2698 Gravois Rd High Ridge MO 63049-2508
Phone: (636) 677-1166
Fax: (636) 677-1324
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 046-009535 Illinois
Eye and Vision Services Providers / Optometrist 152W00000X 2003014792 Missouri

Profile Details

NPI number 1548210032
LBN Legal business name Thatch, Lisa
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 12th, 2006
Last updated Apr 12th, 2019 - about 5 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1548210032 NPPES
Illinois Other P00040122 MEDICARE RAILROAD
Illinois Other 0814870023 MEDICARE RAILROAD
Illinois Other 087817 MEDICARE RAILROAD
Illinois MEDICAID 046009535 MEDICARE RAILROAD
Illinois Other IL9535 MEDICARE RAILROAD
Illinois Other 0814870026 MEDICARE RAILROAD
Illinois Other 252039 MEDICARE RAILROAD
Illinois Other 0814870010 MEDICARE RAILROAD

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