Provider Demographics
NPI:1366502981
Name:MATSUI, LISA R (OD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:R
Last Name:MATSUI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2572 SAN SABA ST
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-8001
Mailing Address - Country:US
Mailing Address - Phone:714-731-5031
Mailing Address - Fax:714-671-0820
Practice Address - Street 1:400 W LAMBERT RD STE A
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-3936
Practice Address - Country:US
Practice Address - Phone:714-256-2040
Practice Address - Fax:714-671-0820
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10233T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist