Healthcare Provider Details

I. General information

NPI: 1629207451
Provider Name (Legal Business Name): LISA MARIE HEUER OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA MARIE CRAIG OD

II. Dates (important events)

Enumeration Date: 07/14/2009
Last Update Date: 06/12/2023
Certification Date: 06/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 COLLEGE ST
WOODLAND CA
95695-3908
US

IV. Provider business mailing address

433 COLLEGE ST
WOODLAND CA
95695-3908
US

V. Phone/Fax

Practice location:
  • Phone: 530-662-2020
  • Fax: 530-662-8642
Mailing address:
  • Phone: 530-662-2020
  • Fax: 530-662-8642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number13751
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: