Provider Demographics
NPI:1306830443
Name:KRALIAN, LISA M (OD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:KRALIAN
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 1:16 LELAND ST
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:MA
Mailing Address - Zip Code:01519-1414
Mailing Address - Country:US
Mailing Address - Phone:508-839-4283
Mailing Address - Fax:
Practice Address - Street 1:31 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:MA
Practice Address - Zip Code:01570-4307
Practice Address - Country:US
Practice Address - Phone:508-943-1050
Practice Address - Fax:508-943-6900
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-05
Last Update Date:2022-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3201 TP152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA21499OtherFALLON
MA997312OtherNETWORK HEALTH
MD151733OtherHARVARD PILGRIM
MA23732OtherCIGNA
MA0353159Medicaid
MA725510OtherTUFTS
MAPVN2209490OtherAETNA
MAW15659OtherBC/BS OF MA
MAPVN2209490OtherAETNA
MAT92396Medicare UPIN