Individual
LISA M TRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
775 W CORBETT AVE, SWANSBORO, NC 28584-8562
(910) 326-3050
(910) 326-7088
Mailing address
276 LIVE OAK RD, NEWPORT, NC 28570-5143
(919) 780-7980
(910) 347-6663
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2010
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
093UP
BLUE CROSS BLUE SHIELD
NC
05
—
5903814
—
NC
Enumeration date
04/14/2006
Last updated
12/09/2022
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