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General NPI Number Information
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NPI Number | 1538056973
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Entity Type | Individual
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Provider Name | LISA ROBERTS ISEMAN LDO
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Gender | Female
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Dates
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Enumeration Date | 06/19/2025
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Last Update Date | 06/19/2025
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Provider Practice Location Address
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Address Line | 976 COMMONWEALTH BLVD
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City | MARTINSVILLE
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State | VA
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Zip | 24112-1887
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Country | US
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Telephone | 276-634-5697
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Fax | 276-634-5075
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Provider Business Mailing Address
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Address Line | 30 REDWOOD ST
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City | BASSETT
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State | VA
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Zip | 24055-4111
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Country | US
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Telephone | 276-229-8129
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Fax |
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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 | 1101001843
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License Number State | VA
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