Provider Demographics
NPI:1588790273
Name:LISA M. WEISS, O.D. OPTOMETRIC CORP
Entity type:Organization
Organization Name:LISA M. WEISS, O.D. OPTOMETRIC CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:619-444-1153
Mailing Address - Street 1:303 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-3913
Mailing Address - Country:US
Mailing Address - Phone:619-444-1153
Mailing Address - Fax:619-444-1154
Practice Address - Street 1:303 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-3913
Practice Address - Country:US
Practice Address - Phone:619-444-1153
Practice Address - Fax:619-444-1154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11405T152WC0802X, 152WP0200X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
Not Answered152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Multi-Specialty
Not Answered152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Multi-Specialty