Healthcare Provider Details

I. General information

NPI: 1801042643
Provider Name (Legal Business Name): LISA DIANNE NIVEN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2008
Last Update Date: 11/01/2023
Certification Date: 11/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W HOSPITAL RD
FT EISENHOWER GA
30905-5741
US

IV. Provider business mailing address

209 SILVER MEADOW CT
AIKEN SC
29803-1658
US

V. Phone/Fax

Practice location:
  • Phone: 706-787-7155
  • Fax: 706-787-2666
Mailing address:
  • Phone: 225-235-2521
  • Fax: 706-787-2666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1528
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: