MEDICARE: DR. LISA M TESTA 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
1	152W00000X	Optometrist	4179-T681	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4126690001	OTHER	OH	MEDICARE DURABLE MEDICAL GOODS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144215864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA M TESTA O.D.

Provider Business Mailing Address
First Line	:	2694 S MAIN ST
Second Line	:
City	:	COVENTRY TOWNSHIP
State	:	OH
Zip	:	44319-1861
Country	:	US
Telephone Number	:	330-785-5111
Fax Number	:	330-785-5114

Provider Business Practice Location Address
First Line	:	2694 S MAIN ST
Second Line	:
City	:	COVENTRY TOWNSHIP
State	:	OH
Zip	:	44319-1861
Country	:	US
Telephone Number	:	330-785-5111
Fax Number	:	330-785-5114

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	01/15/2021

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