Provider Demographics
NPI:1730266768
Name:BADOWSKI, LISA (OD, MS)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:BADOWSKI
Suffix:
Gender:F
Credentials:OD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2760 OVERLOOK DR
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-6750
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14200 E ALAMEDA AVE
Practice Address - Street 2:JC PENNEY OPTICAL
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-2511
Practice Address - Country:US
Practice Address - Phone:303-344-1272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2407152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T80798Medicare UPIN
BA061933`Medicare PIN