Provider Demographics
NPI:1891858908
Name:REDILLA, LISA A (OD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:REDILLA
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:35000 WARREN RD
Mailing Address - Street 2:WESTLAND CENTER
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-6223
Mailing Address - Country:US
Mailing Address - Phone:734-525-5907
Mailing Address - Fax:734-525-4611
Practice Address - Street 1:35000 WARREN RD
Practice Address - Street 2:WESTLAND CENTER
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-6223
Practice Address - Country:US
Practice Address - Phone:734-525-5907
Practice Address - Fax:734-525-4611
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4901004125152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist