Provider Demographics
NPI:1598768855
Name:WARD, LISA MARIE (MD)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:MARIE
Last Name:WARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:HORESJ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8140 NORTON PKWY STE 110
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-6017
Mailing Address - Country:US
Mailing Address - Phone:440-255-1115
Mailing Address - Fax:440-255-1550
Practice Address - Street 1:8140 NORTON PKWY STE 110
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-6017
Practice Address - Country:US
Practice Address - Phone:440-255-1115
Practice Address - Fax:440-255-1550
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-06-0896-W207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0811983Medicaid
OHD16649Medicare UPIN
OHWA0683601Medicare ID - Type Unspecified