Provider Demographics
NPI:1720072325
Name:TURBEVILLE, LISA HAND (OD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:HAND
Last Name:TURBEVILLE
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 1:264 SHOREWARD DR
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-5146
Mailing Address - Country:US
Mailing Address - Phone:843-236-2020
Mailing Address - Fax:843-650-2525
Practice Address - Street 1:1651 GLENNS BAY RD
Practice Address - Street 2:
Practice Address - City:SURFSIDE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29575-4836
Practice Address - Country:US
Practice Address - Phone:843-650-2400
Practice Address - Fax:843-650-2525
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC968152W00000X
NC1428152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDO9682Medicaid
SCDO9682Medicaid