Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 10095 | CA |
NPI | 1003997933 |
---|---|
Provider Name | Dr. Lisa Marie Shimada |
First Address | La Habra, CA 90631-3972 |
Second Address | La Habra, CA 90631-3972 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 24/07/2008 |