Provider Demographics
NPI:1124035274
Name:O'CONNOR, LISA MARIE (OD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:O'CONNOR
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 1:45 CASTRO STREET
Mailing Address - Street 2:SUITE 318
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-1019
Mailing Address - Country:US
Mailing Address - Phone:415-431-9555
Mailing Address - Fax:415-431-9251
Practice Address - Street 1:45 CASTRO STREET
Practice Address - Street 2:SUITE 318
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-1019
Practice Address - Country:US
Practice Address - Phone:415-431-9555
Practice Address - Fax:415-431-9251
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 11198T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0111981Medicare ID - Type UnspecifiedPPIN
U80826Medicare UPIN