Provider Demographics
NPI:1437150448
Name:BISHOP, LISA (OD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:BISHOP
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 1:239 W JEFFERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-4510
Mailing Address - Country:US
Mailing Address - Phone:214-943-7604
Mailing Address - Fax:
Practice Address - Street 1:1251 E SOUTHLAKE BLVD STE 331
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6478
Practice Address - Country:US
Practice Address - Phone:817-668-6393
Practice Address - Fax:817-524-6018
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA06018001070152W00000X
TX7503TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist