Provider Demographics
NPI:1134147093
Name:GREENE, LISA M (OD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:M
Last Name:GREENE
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 1:559 LONG SHOALS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-8459
Mailing Address - Country:US
Mailing Address - Phone:828-508-1747
Mailing Address - Fax:828-470-1774
Practice Address - Street 1:559 LONG SHOALS RD STE 100
Practice Address - Street 2:
Practice Address - City:ARDEN
Practice Address - State:NC
Practice Address - Zip Code:28704-8459
Practice Address - Country:US
Practice Address - Phone:828-747-9260
Practice Address - Fax:828-470-1774
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1601152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC093PAOtherBCBS OF NC
2470501AMedicare PIN
NCU46155Medicare UPIN