Provider Demographics
NPI:1841333192
Name:TONG, LISE KIM (OD)
Entity type:Individual
Prefix:DR
First Name:LISE
Middle Name:KIM
Last Name:TONG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:86 TARA RD
Mailing Address - Street 2:
Mailing Address - City:ORINDA
Mailing Address - State:CA
Mailing Address - Zip Code:94563-3128
Mailing Address - Country:US
Mailing Address - Phone:925-254-7491
Mailing Address - Fax:925-254-6300
Practice Address - Street 1:958 MORAGA RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-4525
Practice Address - Country:US
Practice Address - Phone:925-283-3821
Practice Address - Fax:925-283-3881
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA8601T152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU18986Medicare UPIN