MEDICARE: DR. LISA M GALSTIAN O.D.

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	152W00000X	Optometrist	T08231	CA

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	:	1003956731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA M GALSTIAN O.D.

Provider Business Mailing Address
First Line	:	1697 CALLE ALTA
Second Line	:
City	:	LA JOLLA
State	:	CA
Zip	:	92037-7105
Country	:	US
Telephone Number	:	858-273-3919
Fax Number	:	858-273-5021

Provider Business Practice Location Address
First Line	:	7770 REGENTS RD
Second Line	:	SUITE 104
City	:	SAN DIEGO
State	:	CA
Zip	:	92122-1937
Country	:	US
Telephone Number	:	858-546-1940
Fax Number	:	858-546-0940

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

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	07/09/2007

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