Healthcare Provider Details

I. General information

NPI: 1841632809
Provider Name (Legal Business Name): MICHAEL ROBERT LACINA O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2013
Last Update Date: 08/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

187 SCHARBERRY LN
MARS PA
16046-2429
US

IV. Provider business mailing address

131 CHERRINGTON DR
CRANBERRY TWP PA
16066-3159
US

V. Phone/Fax

Practice location:
  • Phone: 724-591-5501
  • Fax:
Mailing address:
  • Phone: 724-493-0939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG002750
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number6210
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: