Provider Demographics
NPI:1891735916
Name:PARKE, LISA A (OD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:A
Last Name:PARKE
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 1:1524 NC HIGHWAY 24 87
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:NC
Mailing Address - Zip Code:28326-9424
Mailing Address - Country:US
Mailing Address - Phone:910-223-5410
Mailing Address - Fax:910-223-5119
Practice Address - Street 1:1524 NC HIGHWAY 24 87
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:NC
Practice Address - Zip Code:28326-9424
Practice Address - Country:US
Practice Address - Phone:910-223-5410
Practice Address - Fax:910-223-5119
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1871152W00000X, 152WC0802X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC161680430OtherSUPERIOR VISION
NC220647OtherEYEMED
NC220647, 220648OtherCOLE VISION
NC7412606OtherAETNA
NC093R6OtherBCBS
NC161680430OtherMAILHANDLERS
NC24960OtherSPECTERA
NC161680430OtherTRICARE
NC7412606OtherAETNA
NC093R6OtherBCBS