MEDICARE: DR. LISA STRAND BALOIAN OD

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	12545TPG	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12545	OTHER	CA	BOARD OF OPTOMETRY LICENSE

General Provider Information

NPI Number	:	1346297322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA STRAND BALOIAN OD

Provider Business Mailing Address
First Line	:	PO BOX 2127
Second Line	:
City	:	EL GRANADA
State	:	CA
Zip	:	94018-2127
Country	:	US
Telephone Number	:	415-672-9509
Fax Number	:

Provider Business Practice Location Address
First Line	:	1719 NORIEGA ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94122-4307
Country	:	US
Telephone Number	:	628-256-2177
Fax Number	:	415-500-2738

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

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	09/27/2024

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