Individual
DR. LISA RENEE LAGASSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
20525 MACK AVE, GROSSE POINTE WOODS, MI 48236-1655
(313) 881-6622
(313) 881-9380
Mailing address
42260 DHARTE CT, CLINTON TOWNSHIP, MI 48038-6433
(586) 801-4309
(313) 881-9380
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901003663
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
204683
COLE PROVIDER #
MI
01
—
90-0-H2-2311-0
BCBS #
MI
Enumeration date
10/07/2005
Last updated
02/15/2024
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