Provider Demographics
NPI:1093724981
Name:THOMAS, LISA (OD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:THOMAS-MATHEW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2802 BUSINESS CENTER DR
Mailing Address - Street 2:STE 114
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-2188
Mailing Address - Country:US
Mailing Address - Phone:832-228-7759
Mailing Address - Fax:281-208-0236
Practice Address - Street 1:2802 BUSINESS CENTER DR
Practice Address - Street 2:SUITE #114
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-2148
Practice Address - Country:US
Practice Address - Phone:832-228-7759
Practice Address - Fax:281-208-0236
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6801 TG152WC0802X, 152WP0200X, 152WV0400X, 152WX0102X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPO145632OtherDPS REGISTRATION #
TX6801 TGOtherSTATE LICENSE #
TXMT1395082OtherDEA #