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General NPI Number Information
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NPI Number | 1891719845
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Entity Type | Individual
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Provider Name | LISA CAROL DUDLEY O.D.
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Gender | Female
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3061 N SHARON AMITY RD
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City | CHARLOTTE
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State | NC
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Zip | 28205-6600
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Country | US
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Telephone | 704-567-6755
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Fax | 704-567-0238
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Provider Business Mailing Address
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Address Line | 3515 SELWYN AVE
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City | CHARLOTTE
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State | NC
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Zip | 28209-3501
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Country | US
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Telephone | 704-521-2719
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Fax | 704-567-0238
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1924
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License Number State | NC
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