Provider Demographics
NPI:1750325478
Name:GRAYBEAL, LISA ELIZABETH
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ELIZABETH
Last Name:GRAYBEAL
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:ELIZABETH
Other - Last Name:GRAYBEAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:141 LILAC MIST LOOP
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-8701
Mailing Address - Country:US
Mailing Address - Phone:704-315-9171
Mailing Address - Fax:
Practice Address - Street 1:150 CONCORD COMMONS PL SW
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-5026
Practice Address - Country:US
Practice Address - Phone:704-721-5530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1891152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist