Provider Demographics
NPI:1689781916
Name:JUSTICE, LISA F (OD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:F
Last Name:JUSTICE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:10360 MEDLOCK BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-5927
Mailing Address - Country:US
Mailing Address - Phone:770-476-1220
Mailing Address - Fax:770-232-0394
Practice Address - Street 1:10360 MEDLOCK BRIDGE RD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-5927
Practice Address - Country:US
Practice Address - Phone:770-476-1220
Practice Address - Fax:770-232-0394
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA1188T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist