Provider Demographics
NPI:1487659553
Name:GENOVESE, LISA MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARIE
Last Name:GENOVESE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:MACLAUGHLIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:6053 CORINNE LN
Mailing Address - Street 2:
Mailing Address - City:CLARENCE CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:14032-9510
Mailing Address - Country:US
Mailing Address - Phone:716-741-0019
Mailing Address - Fax:
Practice Address - Street 1:2825 NIAGARA FALLS BLVD
Practice Address - Street 2:STE 130
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228-2021
Practice Address - Country:US
Practice Address - Phone:716-564-2020
Practice Address - Fax:716-564-2060
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006562-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
7290258OtherINDEPENDENT HEALTH
NY000390208003OtherCOMMUNITY BLUE
NY02443465Medicaid
NY251744484OtherNOVA
NY251744484OtherEMPIRE - UNITED HEALTHCAR
NY161578122OtherEMPIRE - UNITED HEALTHCAR
NY251744484OtherNORTH AMERICAN PREFERRED
NYP00412826OtherMEDICARE RAILROAD
NY000390208004OtherCOMMUNITY BLUE
NY161578122OtherNOVA
NYRA2053Medicare PIN
NY000390208004OtherCOMMUNITY BLUE
NY161578122OtherEMPIRE - UNITED HEALTHCAR