Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 3912 | MA |
NPI | 1013074533 |
---|---|
Provider Name | Dr. Lisa Marie Pilleri |
First Address | Saugus, MA 01906-3143 |
Second Address | Saugus, MA 01906-3143 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2007 |
Last Update Date | 22/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0369381 | (05) | MA |