Provider Demographics
NPI:1003084393
Name:LEWIS S BLISS MD
Entity Type:Organization
Organization Name:LEWIS S BLISS MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:HASSON
Authorized Official - Last Name:HILLARIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-863-2614
Mailing Address - Street 1:5773 GREENBACK LN
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95841-2013
Mailing Address - Country:US
Mailing Address - Phone:916-863-3143
Mailing Address - Fax:916-863-3148
Practice Address - Street 1:5773 GREENBACK LN
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95841-2013
Practice Address - Country:US
Practice Address - Phone:916-863-3143
Practice Address - Fax:916-863-3148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC42178207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0319160001Medicare PIN
CA00C421780Medicare PIN