Provider Demographics
NPI:1306833314
Name:LORENZO, LISA MARIE (OD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:LORENZO
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 1:103 BETHANY DR
Mailing Address - Street 2:
Mailing Address - City:MC MURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-2909
Mailing Address - Country:US
Mailing Address - Phone:724-942-2260
Mailing Address - Fax:412-655-6513
Practice Address - Street 1:2027 LEBANON CHURCH RD
Practice Address - Street 2:
Practice Address - City:WEST MIFFLIN
Practice Address - State:PA
Practice Address - Zip Code:15122-2461
Practice Address - Country:US
Practice Address - Phone:412-655-6513
Practice Address - Fax:412-655-6513
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000136152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1475302 05Medicaid
PA410036489OtherRAILROAD MEDICARE
PAU51068Medicare UPIN
PA443190LWXMedicare PIN