Provider Demographics
NPI:1558830018
Name:WAN, LISHA CAYE (OD)
Entity Type:Individual
Prefix:
First Name:LISHA
Middle Name:CAYE
Last Name:WAN
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 1:1700 N ROSE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-3791
Mailing Address - Country:US
Mailing Address - Phone:805-983-0700
Mailing Address - Fax:
Practice Address - Street 1:1700 N ROSE AVE #200
Practice Address - Street 2:SUITE 200
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-9303
Practice Address - Country:US
Practice Address - Phone:805-983-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-14
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34155152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist