Provider Demographics
NPI:1639241789
Name:PARISI, LEANNA M (OD)
Entity Type:Individual
Prefix:DR
First Name:LEANNA
Middle Name:M
Last Name:PARISI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MRS
Other - First Name:LEANNA
Other - Middle Name:M
Other - Last Name:TIERNEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:4515 CENTRAL AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2374
Mailing Address - Country:US
Mailing Address - Phone:951-784-2420
Mailing Address - Fax:909-784-4713
Practice Address - Street 1:4515 CENTRAL AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2374
Practice Address - Country:US
Practice Address - Phone:951-784-2420
Practice Address - Fax:909-784-4713
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8829T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U33472Medicare UPIN
SD0088290Medicare ID - Type Unspecified