Provider Demographics
NPI:1801042643
Name:NIVEN, LISA DIANNE (OD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:DIANNE
Last Name:NIVEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:209 SILVER MEADOW CT
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-1658
Mailing Address - Country:US
Mailing Address - Phone:225-235-2521
Mailing Address - Fax:706-787-2666
Practice Address - Street 1:300 W HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:FT EISENHOWER
Practice Address - State:GA
Practice Address - Zip Code:30905-5741
Practice Address - Country:US
Practice Address - Phone:706-787-7155
Practice Address - Fax:706-787-2666
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC1528152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD15281Medicaid