Moon, Lisa Elaine
Moon, Lisa Elaine is an sole proprietor health care provider with primary practice located at 360 Sierra College Dr Suite 100, Grass Valley CA 95945-5088. She recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as her primary health care specialty. Moon, Lisa Elaine can be contacted via phone (530) 273-3190.Contact Information
Primary practice address
360 Sierra College Dr Suite 100
Grass Valley CA 95945-5088
Phone: (530) 273-3190
Fax: (530) 273-5541
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 6088T | California |
Profile Details
| NPI number | 1174592869 |
|---|---|
| LBN Legal business name | Moon, Lisa Elaine |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Mar 15th, 2006 |
| Last updated | Jun 15th, 2024 - about 3 months ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1174592869 | NPPES |
| Other | YYY49206Y | GROUP MEDICARE PIN | |
| MEDICAID | YYY49206Y | GROUP MEDICARE PIN | |
| Other | 0366860001 | GROUP MEDICARE PIN |
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