Provider Demographics
NPI:1679311674
Name:THOMAS, LIZABETH PAULINO (OD)
Entity type:Individual
Prefix:
First Name:LIZABETH
Middle Name:PAULINO
Last Name:THOMAS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 SIERRA COLLEGE DR STE A
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5093
Mailing Address - Country:US
Mailing Address - Phone:530-272-3411
Mailing Address - Fax:
Practice Address - Street 1:400 SIERRA COLLEGE DR STE A
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5093
Practice Address - Country:US
Practice Address - Phone:530-272-3411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35796152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management