MEDICARE: LISA BOHRA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207WX0110X	Pediatric Ophthalmology and Strabismus Specialist Physician	4301070213	MI
2	207W00000X	Ophthalmology Physician	4301070213	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184687980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA BOHRA MD

Provider Business Mailing Address
First Line	:	6689 ORCHARD LAKE RD # 297
Second Line	:	CHILDRENS EYE CARE PC
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-3404
Country	:	US
Telephone Number	:	248-254-8140
Fax Number	:	248-254-8150

Provider Business Practice Location Address
First Line	:	7001 ORCHARD LAKE RD
Second Line	:	200
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-3604
Country	:	US
Telephone Number	:	248-538-7400
Fax Number	:	248-538-7403

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2006
Last Update Date	:	05/23/2024

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Directions to “ LISA BOHRA MD” Practice Location

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