MEDICARE: LISA MARIE LORENZO 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	OEG000136	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	410036489	OTHER	PA	RAILROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1306833314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA MARIE LORENZO O.D.

Provider Business Mailing Address
First Line	:	103 BETHANY DR
Second Line	:
City	:	MC MURRAY
State	:	PA
Zip	:	15317-2909
Country	:	US
Telephone Number	:	724-942-2260
Fax Number	:	412-655-6513

Provider Business Practice Location Address
First Line	:	2027 LEBANON CHURCH RD
Second Line	:
City	:	WEST MIFFLIN
State	:	PA
Zip	:	15122-2461
Country	:	US
Telephone Number	:	412-655-6513
Fax Number	:	412-655-6513

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

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	10/02/2008

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