Organization
LISA R KANFOUSH OD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LISA RAE KANFOUSH OD (OWNER)
(724) 378-4457
Entity
Organization
Contact information
Practice address
131 PLEASANT DR STE 4U, ALIQUIPPA, PA 15001-1300
(724) 622-6467
(724) 378-4547
Mailing address
131 PLEASANT DR STE 4U, ALIQUIPPA, PA 15001-1300
(724) 622-6467
(724) 378-4547
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0004329329
AETNA
PA
01
—
0009739462
AETNA
—
01
—
065944RBR
MEDICARE
PA
01
—
1003814559
UNITED HEALTH CARE
PA
01
—
1114996105
NPI
PA
01
—
11149961050
NPI
PA
01
—
1547972
GATEWAY
PA
01
—
251892272
CIGNA
PA
01
—
2792074
BLUE CROSS BLUE SHIELD
PA
01
—
312055
UPMC
PA
01
—
314110
UPMC
PA
01
—
701466
HIGHMARK
PA
01
—
92272
MEDICARE
PA
Enumeration date
11/16/2018
Last updated
11/16/2018
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