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NPI Code Detail

MEDICARE: MISS LISA L NIRODE O.D.

MEDICARE: MISS LISA L NIRODE 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
1152W00000XOptometrist3684 T579OH

Other Identifiers

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

General Provider Information

NPI Number : 1528012077
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS LISA L NIRODE O.D.
Provider Business Mailing Address
First Line : 28370 KENSINGTON LN STE A
Second Line :
City : PERRYSBURG
State : OH
Zip : 43551-4180
Country : US
Telephone Number : 419-865-3866
Fax Number : 419-865-3451
Provider Business Practice Location Address
First Line : 1200 S DETROIT AVE
Second Line :
City : TOLEDO
State : OH
Zip : 43614-5903
Country : US
Telephone Number : 419-259-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2006
Last Update Date : 03/10/2026

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