Provider Demographics
NPI:1104543933
Name:HILL, LISA LEAH
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:LEAH
Last Name:HILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 BLUFFTON RD
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-7621
Mailing Address - Country:US
Mailing Address - Phone:843-815-3891
Mailing Address - Fax:843-815-3897
Practice Address - Street 1:4 BLUFFTON RD
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-7621
Practice Address - Country:US
Practice Address - Phone:843-815-3891
Practice Address - Fax:843-815-3897
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1337156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician