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General NPI Number Information
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NPI Number | 1841333192
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Entity Type | Individual
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Provider Name | LISE KIM TONG O.D.
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Gender | Female
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 958 MORAGA RD
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City | LAFAYETTE
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State | CA
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Zip | 94549-4525
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Country | US
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Telephone | 925-283-3821
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Fax | 925-283-3881
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Provider Business Mailing Address
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Address Line | 86 TARA RD
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City | ORINDA
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State | CA
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Zip | 94563-3128
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Country | US
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Telephone | 925-254-7491
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Fax | 925-254-6300
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WL0500X
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Taxonomy Name | Low Vision Rehabilitation Optometrist
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License Number | 8601T
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License Number State | CA
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