Lisa Moffitt, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

PA0EG000769 Issued in PA

Practice address

16086 Conneaut Lake Rd
Walmart Vision Center
Meadville, PA 16335-3884

Phone

(816) 337-4426

Fax

(814) 337-4320

NPI assigned

Aug 1, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1480550400000",
    "number": "1104833615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 TRINITY POINT DR",
            "address_2": "WALMART VISION CENTER",
            "city": "WASHINGTON",
            "state": "PA",
            "postal_code": "153012974",
            "telephone_number": "724-229-7769",
            "fax_number": "724-229-7792"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16086 CONNEAUT LAKE RD",
            "address_2": "WALMART VISION CENTER",
            "city": "MEADVILLE",
            "state": "PA",
            "postal_code": "163353884",
            "telephone_number": "816-337-4426",
            "fax_number": "814-337-4320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOFFITT",
        "first_name": "LISA",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-01",
        "last_updated": "2016-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "PA",
            "license": "PA0EG000769",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "0000027186",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "376852",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PA DEPT OF HUMAN SERVICES",
            "identifier": "001746361 0003",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROMISE WELFARE",
            "identifier": "0017463610003",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DAVIS",
            "identifier": "52269",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dustin Joel Mitchell, O.D.
• Kaela M Mitchell
• Thomas J Mitchell, M.D.
• MMC Pharmacy Inc
• MMC Pharmacy Inc
• Bryan Douglas Moles, D.O.
• Ryan G Molli, DO
• Moon Chiropractic, PC
• Joseph Michael Moon, DC
• Sarah Emily Moore, LSW

• Optometrist in Meadville, PA
• Providers in Meadville, PA by specialty
• Optometrist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.