Provider Demographics
NPI:1568210896
Name:PITTS, LISA (LDO)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:PITTS
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 GLENN SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-3515
Mailing Address - Country:US
Mailing Address - Phone:919-688-3259
Mailing Address - Fax:919-688-3281
Practice Address - Street 1:1525 GLENN SCHOOL RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-3515
Practice Address - Country:US
Practice Address - Phone:919-688-3259
Practice Address - Fax:919-688-3281
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC943156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician