MEDICARE: DR. LISA M HARRISON 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	13010TPA	CA

General Provider Information

NPI Number	:	1023101920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA M HARRISON O.D.

Provider Business Mailing Address
First Line	:	2575 YORBA LINDA BLVD
Second Line	:
City	:	FULLERTON
State	:	CA
Zip	:	92831-1615
Country	:	US
Telephone Number	:	714-449-7428
Fax Number	:	714-992-7871

Provider Business Practice Location Address
First Line	:	2575 YORBA LINDA BLVD
Second Line	:
City	:	FULLERTON
State	:	CA
Zip	:	92831-1615
Country	:	US
Telephone Number	:	714-449-7428
Fax Number	:	714-992-7871

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	04/07/2020

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