Provider Demographics
NPI:1851540611
Name:IRIZARRY, LIZZETTE MARIA (OD)
Entity Type:Individual
Prefix:
First Name:LIZZETTE
Middle Name:MARIA
Last Name:IRIZARRY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:LIZZETTE
Other - Middle Name:MARIA
Other - Last Name:IRIZARRY LOYOLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:PO BOX 363942
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-3942
Mailing Address - Country:US
Mailing Address - Phone:787-649-2045
Mailing Address - Fax:
Practice Address - Street 1:301 CARR. 2
Practice Address - Street 2:SUITE 2
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-0000
Practice Address - Country:US
Practice Address - Phone:787-854-6639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-16
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR386152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist