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NPI Code Detail

MEDICARE: DR. LISA MARIE GENOVESE O.D.

MEDICARE: DR. LISA MARIE GENOVESE O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometristTUV006562-1NY

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
8P00412826OTHERNYMEDICARE RAILROAD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
17290258OTHERINDEPENDENT HEALTH
2000390208003OTHERNYCOMMUNITY BLUE
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4251744484OTHERNYNOVA
5251744484OTHERNYEMPIRE - UNITED HEALTHCAR
6161578122OTHERNYEMPIRE - UNITED HEALTHCAR
7251744484OTHERNYNORTH AMERICAN PREFERRED
9000390208004OTHERNYCOMMUNITY BLUE
10161578122OTHERNYNOVA

General Provider Information

NPI Number : 1487659553
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LISA MARIE GENOVESE O.D.
Provider Business Mailing Address
First Line : 6053 CORINNE LN
Second Line :
City : CLARENCE CENTER
State : NY
Zip : 14032-9510
Country : US
Telephone Number : 716-741-0019
Fax Number :
Provider Business Practice Location Address
First Line : 2825 NIAGARA FALLS BLVD
Second Line : STE 130
City : AMHERST
State : NY
Zip : 14228-2021
Country : US
Telephone Number : 716-564-2020
Fax Number : 716-564-2060
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2005
Last Update Date : 01/22/2010

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