Healthcare Provider Details

I. General information

NPI: 1235659517
Provider Name (Legal Business Name): LISA CHAO OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 06/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 TOWER WAY STE 150
BAKERSFIELD CA
93309-1586
US

IV. Provider business mailing address

7447 N FIGUEROA ST STE 200
LOS ANGELES CA
90041-1721
US

V. Phone/Fax

Practice location:
  • Phone: 661-327-4499
  • Fax:
Mailing address:
  • Phone: 323-257-3300
  • Fax: 323-257-3200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number33722TLG
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: