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General NPI Number Information
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NPI Number | 1437441961
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Entity Type | Organization
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Legal Business Name | LISA A REDILLA OD PLLC
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Dates
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Enumeration Date | 05/02/2011
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Last Update Date | 05/02/2011
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Provider Practice Location Address
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Address Line | 29500 7 MILE RD
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City | LIVONIA
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State | MI
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Zip | 48152-1910
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Country | US
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Telephone | 248-477-2662
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Fax |
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Provider Business Mailing Address
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Address Line | 38197 LANCASTER ST
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City | LIVONIA
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State | MI
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Zip | 48154-1509
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Country | US
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Telephone | 734-945-0555
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LISA A REDILLA
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Credential | OD
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Telephone | 734-945-0555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4901004125
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License Number State | MI
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