Provider Demographics
NPI:1891759924
Name:TRY, LISA M (OD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:TRY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:BELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:276 LIVE OAK RD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28570-5143
Mailing Address - Country:US
Mailing Address - Phone:919-780-7980
Mailing Address - Fax:910-347-6663
Practice Address - Street 1:775 W CORBETT AVE
Practice Address - Street 2:
Practice Address - City:SWANSBORO
Practice Address - State:NC
Practice Address - Zip Code:28584-8562
Practice Address - Country:US
Practice Address - Phone:910-326-3050
Practice Address - Fax:910-326-7088
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2010152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5903814Medicaid
NC093UPOtherBLUE CROSS BLUE SHIELD
NC2474010BMedicare PIN