Provider Demographics
NPI:1598790636
Name:MARTIN, LISA K (OD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:K
Last Name:MARTIN
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 1:1610 ROCK SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-6177
Mailing Address - Country:US
Mailing Address - Phone:615-355-6677
Mailing Address - Fax:615-355-6670
Practice Address - Street 1:1610 ROCK SPRINGS RD
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-6177
Practice Address - Country:US
Practice Address - Phone:615-355-6677
Practice Address - Fax:615-355-6670
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNODT 2188152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN810552726OtherCIGNA, UHC
TN3944289Medicaid
TN4041310OtherBCBS
TN3944289Medicaid