Provider Demographics
NPI:1144242629
Name:SHIROISHI, LISA Y (OD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:Y
Last Name:SHIROISHI
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 1:240 MERIDIAN AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2927
Mailing Address - Country:US
Mailing Address - Phone:408-294-3722
Mailing Address - Fax:408-294-2408
Practice Address - Street 1:240 MERIDIAN AVE STE 3
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-2927
Practice Address - Country:US
Practice Address - Phone:408-294-3722
Practice Address - Fax:408-294-2408
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11212T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD112120Medicaid
CA1144242629Medicare UPIN
CASD112120Medicare PIN