Provider Demographics
NPI:1770640898
Name:SMITH, LISA GAIL (OD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:GAIL
Last Name:SMITH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:P.O. BOX 388
Mailing Address - Street 2:
Mailing Address - City:UXBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01569
Mailing Address - Country:US
Mailing Address - Phone:508-476-2015
Mailing Address - Fax:508-476-1234
Practice Address - Street 1:1044 G.A.R. HIGHWAY #C
Practice Address - Street 2:SWANSEA VISION CENTER
Practice Address - City:SWANSEA
Practice Address - State:MA
Practice Address - Zip Code:02777
Practice Address - Country:US
Practice Address - Phone:508-675-7725
Practice Address - Fax:508-676-3079
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4084152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist