Provider Demographics
NPI:1184613408
Name:LIZZA, CATHLEEN A (OD)
Entity type:Individual
Prefix:DR
First Name:CATHLEEN
Middle Name:A
Last Name:LIZZA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:CATHLEEN
Other - Middle Name:A
Other - Last Name:MUZIKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:118 S PITTSBURGH ST
Mailing Address - Street 2:
Mailing Address - City:CONNELLSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15425-3531
Mailing Address - Country:US
Mailing Address - Phone:724-628-3710
Mailing Address - Fax:
Practice Address - Street 1:118 S PITTSBURGH ST
Practice Address - Street 2:
Practice Address - City:CONNELLSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15425-3531
Practice Address - Country:US
Practice Address - Phone:724-628-3710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-19
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA6364152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT30835Medicare UPIN