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General NPI Number Information
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NPI Number | 1306712005
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Entity Type | Individual
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Provider Name | BRIAN LISI LDO, ABOC, NCLEC
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Gender | Male
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Dates
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Enumeration Date | 10/11/2025
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Last Update Date | 10/11/2025
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Provider Practice Location Address
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Address Line | 3040 BATTLEFIELD PKWY
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City | FORT OGLETHORPE
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State | GA
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Zip | 30742-4004
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Country | US
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Telephone | 706-861-5622
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Fax | 706-861-5704
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Provider Business Mailing Address
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Address Line | 40 E CAROLYN CIR
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City | RINGGOLD
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State | GA
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Zip | 30736-5523
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Country | US
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Telephone | 614-565-0365
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Fax | 706-861-5704
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | LDO003080
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License Number State | GA
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