Provider Demographics
NPI:1538056973
Name:ISEMAN, LISA ROBERTS (LDO)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ROBERTS
Last Name:ISEMAN
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 REDWOOD ST
Mailing Address - Street 2:
Mailing Address - City:BASSETT
Mailing Address - State:VA
Mailing Address - Zip Code:24055-4111
Mailing Address - Country:US
Mailing Address - Phone:276-229-8129
Mailing Address - Fax:
Practice Address - Street 1:976 COMMONWEALTH BLVD
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-1887
Practice Address - Country:US
Practice Address - Phone:276-634-5697
Practice Address - Fax:276-634-5075
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-19
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1101001843156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician