Provider Demographics
NPI:1780804658
Name:SLAVIT, LISA ANNE (OD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:ANNE
Last Name:SLAVIT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:464 MAUREEN AVE
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-3620
Mailing Address - Country:US
Mailing Address - Phone:650-565-9833
Mailing Address - Fax:
Practice Address - Street 1:253 ALMENDRA AVE
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95030-7210
Practice Address - Country:US
Practice Address - Phone:408-399-9009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9885T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist