MEDICARE: DR. LIEZL R. SUTIJONO 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	007100	NY
2	152W00000X	Optometrist	13658	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OP2839	OTHER	CA	EYEMED
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548314750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LIEZL R. SUTIJONO O.D.

Provider Business Mailing Address
First Line	:	6562 WHITBOURNE DR
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95120-4553
Country	:	US
Telephone Number	:	650-892-4809
Fax Number	:

Provider Business Practice Location Address
First Line	:	529 HAYES ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94102-4213
Country	:	US
Telephone Number	:	415-553-6166
Fax Number	:	415-553-6168

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

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	05/23/2012

Similar Medicare Providers

1881914000 — GRUPO MEDICO POLICLINICA SAN PEDRO MEDICARE ADVANTAGE
Practice Location Address:

211 CALLE MORSE
ARROYO, PR
00714-2350

Practice Phone: 787-839-3980
Practice Fax: 787-271-2515

1568537496 — DR. ANGELA TAM OD
Practice Location Address:

529 HAYES ST
SAN FRANCISCO, CA
94102-4213

Practice Phone: 415-553-6166
Practice Fax: 415-553-6168

1164599619 — DR. THERESE LANGILLE O.D.
Practice Location Address:

529 HAYES ST
SAN FRANCISCO, CA
94102-4213

Practice Phone: 415-553-6166
Practice Fax:

1447575477 — THROUGH THE HAYES OPTOMETRY INC
Practice Location Address:

529 HAYES ST
SAN FRANCISCO, CA
94102-4213

Practice Phone: 415-553-6166
Practice Fax: 415-553-6168

1639776727 — ZIYUN HUANG
Practice Location Address:

2021 MORAGA ST
SAN FRANCISCO, CA
94122-4213

Practice Phone: 415-823-3398
Practice Fax:

1972632172 — AQUATIC THERAPY ASSOCIATES
Practice Location Address:

200 N SAN PEDRO RD
SAN RAFAEL, CA
94903-4213

Practice Phone: 415-507-9800
Practice Fax:

Directions to “ DR. LIEZL R. SUTIJONO O.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.