MEDICARE: DR. LISA MARIE HEUER 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	13751	CA

General Provider Information

NPI Number	:	1629207451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA MARIE HEUER OD

Provider Business Mailing Address
First Line	:	433 COLLEGE ST
Second Line	:
City	:	WOODLAND
State	:	CA
Zip	:	95695-3908
Country	:	US
Telephone Number	:	530-662-2020
Fax Number	:	530-662-8642

Provider Business Practice Location Address
First Line	:	433 COLLEGE ST
Second Line	:
City	:	WOODLAND
State	:	CA
Zip	:	95695-3908
Country	:	US
Telephone Number	:	530-662-2020
Fax Number	:	530-662-8642

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

Provider Enumeration Date	:	07/14/2009
Last Update Date	:	06/12/2023

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