Healthcare Provider Details

I. General information

NPI: 1306833314
Provider Name (Legal Business Name): LISA MARIE LORENZO O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 10/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2027 LEBANON CHURCH RD
WEST MIFFLIN PA
15122-2461
US

IV. Provider business mailing address

103 BETHANY DR
MC MURRAY PA
15317-2909
US

V. Phone/Fax

Practice location:
  • Phone: 412-655-6513
  • Fax: 412-655-6513
Mailing address:
  • Phone: 724-942-2260
  • Fax: 412-655-6513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG000136
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: