Provider Demographics
NPI:1356595938
Name:LISA M. GREENE OD PA
Entity type:Organization
Organization Name:LISA M. GREENE OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:828-508-1747
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:828-474-1774
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:828-508-1747
Practice Address - Fax:828-470-1774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-10
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1601152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty