Provider Demographics
NPI:1053553453
Name:CUDA MCCARRON, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:CUDA MCCARRON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8417 DOLOMITE LN
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-4614
Mailing Address - Country:US
Mailing Address - Phone:608-848-1737
Mailing Address - Fax:
Practice Address - Street 1:5500 E CHERYL PKWY
Practice Address - Street 2:SUITE 103
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53711-5336
Practice Address - Country:US
Practice Address - Phone:608-273-3937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-31
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician