MEDICARE: LISA STEINHOFF ABO

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	156FX1800X	Optician	D6964	CA

General Provider Information

NPI Number	:	1467665356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA STEINHOFF ABO

Provider Business Mailing Address
First Line	:	420 THORN ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-5708
Country	:	US
Telephone Number	:	619-298-3586
Fax Number	:	619-298-3682

Provider Business Practice Location Address
First Line	:	420 THORN ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-5708
Country	:	US
Telephone Number	:	619-298-3586
Fax Number	:	619-298-3682

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

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	07/08/2007

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