Provider Demographics
NPI:1851643951
Name:DR. LISA M. ARCIERO OD LLC
Entity Type:Organization
Organization Name:DR. LISA M. ARCIERO OD LLC
Other - Org Name:DR. LISA M. ARCIERO
Other - Org Type:Other Name
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ARCIERO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:860-829-9090
Mailing Address - Street 1:28 CHAMBERLAIN HWY
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06037-1921
Mailing Address - Country:US
Mailing Address - Phone:860-829-9090
Mailing Address - Fax:
Practice Address - Street 1:28 CHAMBERLAIN HWY
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:CT
Practice Address - Zip Code:06037-1921
Practice Address - Country:US
Practice Address - Phone:860-829-9090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-12
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002397152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTU61936Medicare UPIN