Provider Demographics
NPI:1346297322
Name:BALOIAN, LISA STRAND (OD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:STRAND
Last Name:BALOIAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:STRAND
Other - Last Name:BALOIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:PO BOX 2127
Mailing Address - Street 2:
Mailing Address - City:EL GRANADA
Mailing Address - State:CA
Mailing Address - Zip Code:94018-2127
Mailing Address - Country:US
Mailing Address - Phone:415-672-9509
Mailing Address - Fax:
Practice Address - Street 1:1719 NORIEGA ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-4307
Practice Address - Country:US
Practice Address - Phone:628-256-2177
Practice Address - Fax:415-500-2738
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2022-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12545TPG152W00000X
CA12545152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA12545OtherBOARD OF OPTOMETRY LICENSE