Provider Demographics
NPI:1346316064
Name:DE GIULIO, LISA ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:ANN
Last Name:DE GIULIO
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 1:671 ATWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-5322
Mailing Address - Country:US
Mailing Address - Phone:401-421-4821
Mailing Address - Fax:401-421-0928
Practice Address - Street 1:671 ATWOOD AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-5322
Practice Address - Country:US
Practice Address - Phone:401-421-4821
Practice Address - Fax:401-421-0928
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIODTA00431152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9007169Medicaid
71699OtherBLUE CROSS
3048OtherNEIGH HEALTH PLAN
400705OtherBLUE CHIP
419007169Medicare UPIN
71699OtherBLUE CROSS