Provider Demographics
NPI:1003997933
Name:SHIMADA, LISA MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARIE
Last Name:SHIMADA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:601 E WHITTIER BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-3972
Mailing Address - Country:US
Mailing Address - Phone:562-691-2999
Mailing Address - Fax:562-694-0606
Practice Address - Street 1:601 E WHITTIER BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-3972
Practice Address - Country:US
Practice Address - Phone:562-691-2999
Practice Address - Fax:562-694-0606
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10095152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOP10095Medicare PIN