Healthcare Provider Details

I. General information

NPI: 1053553453
Provider Name (Legal Business Name): LISA CUDA MCCARRON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2009
Last Update Date: 03/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 E CHERYL PKWY SUITE 103
FITCHBURG WI
53711-5336
US

IV. Provider business mailing address

8417 DOLOMITE LN
MADISON WI
53719-4614
US

V. Phone/Fax

Practice location:
  • Phone: 608-273-3937
  • Fax:
Mailing address:
  • Phone: 608-848-1737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: