Provider Demographics
NPI:1316967391
Name:KO, LISA K (OD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:K
Last Name:KO
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:618 BLOSSOM HILL RD
Mailing Address - Street 2:100
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-3048
Mailing Address - Country:US
Mailing Address - Phone:408-578-2020
Mailing Address - Fax:408-904-5119
Practice Address - Street 1:618 BLOSSOM HILL RD
Practice Address - Street 2:100
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-3048
Practice Address - Country:US
Practice Address - Phone:408-578-2020
Practice Address - Fax:408-904-5119
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2010-02-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA10352T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist