Provider Demographics
NPI:1952364812
Name:CROSS, LISA C (OD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:C
Last Name:CROSS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2867 WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:MC MURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-3282
Mailing Address - Country:US
Mailing Address - Phone:724-941-3456
Mailing Address - Fax:724-942-0313
Practice Address - Street 1:2867 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:MC MURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-3282
Practice Address - Country:US
Practice Address - Phone:724-941-3456
Practice Address - Fax:724-942-0313
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG-000252152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA308148OtherUPMC
PA01851877Medicaid
PA2428044OtherAETNA
PA0971993OtherCIGNA
PA007989QWUMedicare ID - Type Unspecified
PA0971993OtherCIGNA
PA01851877Medicaid