Provider Demographics
NPI:1154426583
Name:NISHIDA-EUGENIO, LORI SACHIKO (OD)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:SACHIKO
Last Name:NISHIDA-EUGENIO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2427 N LAMER ST
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91504-2228
Mailing Address - Country:US
Mailing Address - Phone:818-823-5411
Mailing Address - Fax:
Practice Address - Street 1:1032 N HOLLYWOOD WAY
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-2525
Practice Address - Country:US
Practice Address - Phone:818-845-3549
Practice Address - Fax:818-846-3204
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9994T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU73344Medicare UPIN
CAWOP9994CMedicare ID - Type UnspecifiedMEDICARE