Provider Demographics
NPI:1790716942
Name:CHOO, LISA H (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:H
Last Name:CHOO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:5979 VINELAND RD STE 214
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-7855
Mailing Address - Country:US
Mailing Address - Phone:407-650-5075
Mailing Address - Fax:407-650-5077
Practice Address - Street 1:5979 VINELAND RD STE 214
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7855
Practice Address - Country:US
Practice Address - Phone:407-650-5075
Practice Address - Fax:407-650-5077
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59892207W00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD02805Medicare UPIN
FL12461YMedicare PIN