Provider Demographics
NPI:1043367717
Name:LIGHTMAN, JANIS MILLER (OD)
Entity Type:Individual
Prefix:DR
First Name:JANIS
Middle Name:MILLER
Last Name:LIGHTMAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 RESPONSE RD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-4807
Mailing Address - Country:US
Mailing Address - Phone:916-614-4015
Mailing Address - Fax:
Practice Address - Street 1:1650 RESPONSE RD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-4807
Practice Address - Country:US
Practice Address - Phone:916-614-4015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8909152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH776377Medicare UPIN