Provider Demographics
NPI:1669101556
Name:SILVA, LISSETTE AIXA (OD)
Entity type:Individual
Prefix:DR
First Name:LISSETTE
Middle Name:AIXA
Last Name:SILVA
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 1:3808 S DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80110-3514
Mailing Address - Country:US
Mailing Address - Phone:832-807-9744
Mailing Address - Fax:
Practice Address - Street 1:98 WADSWORTH BLVD UNIT 118
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-1552
Practice Address - Country:US
Practice Address - Phone:303-749-8802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0003785152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist