Individual
MRS. LISA JO HOUSTON VINAVONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LDO
Contact information
Practice address
2234 PALMYRA RD, ALBANY, GA 31701-1322
(229) 485-9264
(229) 888-3688
Mailing address
2234 PALMYRA RD, ALBANY, GA 31701-1322
(229) 485-9264
(229) 888-3688
Taxonomy
Speciality
Code
Description
License number
State
156FC0801X
Contact Lens Fitter
LDO002657
GA
156FX1800X
Optician
Primary
LDO002657
GA
332H00000X
Eyewear Supplier
LDO002657
GA
Other
Enumeration date
03/16/2016
Last updated
03/16/2016
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