Provider Demographics
NPI:1083091722
Name:LISA S. GREEN, O.D., LLC
Entity Type:Organization
Organization Name:LISA S. GREEN, O.D., LLC
Other - Org Name:I CARE VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:S
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:740-477-2504
Mailing Address - Street 1:1180 N COURT ST
Mailing Address - Street 2:
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43113-1397
Mailing Address - Country:US
Mailing Address - Phone:740-477-2504
Mailing Address - Fax:740-477-1987
Practice Address - Street 1:1180 N COURT ST
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-1397
Practice Address - Country:US
Practice Address - Phone:740-477-2504
Practice Address - Fax:740-477-1987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-01
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4691152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty