Provider Demographics
NPI:1134255854
Name:MADLER, LISA AMY (OPTICIAN)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:AMY
Last Name:MADLER
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:AMY
Other - Last Name:REISCHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OPTICIAN
Mailing Address - Street 1:940 MAYFIELD RD
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1606
Mailing Address - Country:US
Mailing Address - Phone:516-374-9251
Mailing Address - Fax:
Practice Address - Street 1:226 FLATBUSH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-4036
Practice Address - Country:US
Practice Address - Phone:718-622-1880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004687-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY004687-1OtherOPTICIAN LICENSE