Provider Demographics
NPI:1043351083
Name:KHARRAZI, LISA D (OD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:D
Last Name:KHARRAZI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:8 WASHOE CT
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-6867
Mailing Address - Country:US
Mailing Address - Phone:510-517-6494
Mailing Address - Fax:510-865-1549
Practice Address - Street 1:829 BROADWAY
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-4015
Practice Address - Country:US
Practice Address - Phone:510-465-5876
Practice Address - Fax:510-238-5164
Is Sole Proprietor?:No
Enumeration Date:2007-02-11
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA8973T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist