Provider Demographics
NPI:1013074533
Name:PILLERI, LISA MARIE (OD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARIE
Last Name:PILLERI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:MIGNAULT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:335 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SAUGUS
Mailing Address - State:MA
Mailing Address - Zip Code:01906-3143
Mailing Address - Country:US
Mailing Address - Phone:781-233-9570
Mailing Address - Fax:781-233-9571
Practice Address - Street 1:335 MAIN ST
Practice Address - Street 2:
Practice Address - City:SAUGUS
Practice Address - State:MA
Practice Address - Zip Code:01906-3143
Practice Address - Country:US
Practice Address - Phone:781-233-9570
Practice Address - Fax:781-233-9571
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3912152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0369381Medicaid
MA0369381Medicaid