Provider Demographics
NPI:1164904819
Name:PAULINO, LIZANETTE (OD)
Entity Type:Individual
Prefix:
First Name:LIZANETTE
Middle Name:
Last Name:PAULINO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 DULANEY VALLEY RD STE 1335
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-1300
Mailing Address - Country:US
Mailing Address - Phone:410-823-3830
Mailing Address - Fax:
Practice Address - Street 1:825 DULANEY VALLEY RD STE 1335
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-1300
Practice Address - Country:US
Practice Address - Phone:410-823-3830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2641152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist