Provider Demographics
NPI:1447255765
Name:KOTT, LISA J (OD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:J
Last Name:KOTT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:J
Other - Last Name:O'BRIEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2108 HARRISBURG PIKE STE 100
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-2644
Mailing Address - Country:US
Mailing Address - Phone:717-974-9661
Mailing Address - Fax:717-974-9669
Practice Address - Street 1:2108 HARRISBURG PIKE
Practice Address - Street 2:STE 100
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2644
Practice Address - Country:US
Practice Address - Phone:717-974-9661
Practice Address - Fax:717-974-9669
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000551152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU81992Medicare UPIN
PA083187G2GMedicare ID - Type Unspecified