Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 2020-00758 | NC |
N | 207W00000X | Ophthalmologist | A103023 | CA |
NPI | 1023174182 |
---|---|
Provider Name | Dr. Lisa Anne Collea |
First Address | Charlotte, NC 28210-3256 |
Second Address | Charlotte, NC 28210-3256 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2006 |
Last Update Date | 29/04/2021 |