Provider Demographics
NPI:1174894414
Name:TRAINOR, LISA R (RDO)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:R
Last Name:TRAINOR
Suffix:
Gender:F
Credentials:RDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 UXBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MENDON
Mailing Address - State:MA
Mailing Address - Zip Code:01756-1017
Mailing Address - Country:US
Mailing Address - Phone:508-634-3596
Mailing Address - Fax:508-634-3596
Practice Address - Street 1:69 UXBRIDGE RD
Practice Address - Street 2:
Practice Address - City:MENDON
Practice Address - State:MA
Practice Address - Zip Code:01756-1017
Practice Address - Country:US
Practice Address - Phone:508-634-3596
Practice Address - Fax:508-634-3596
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4966156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician