Provider Demographics
NPI:1396745998
Name:LISKA, LANDON LANCE (OD)
Entity type:Individual
Prefix:DR
First Name:LANDON
Middle Name:LANCE
Last Name:LISKA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5801 N 10TH ST
Mailing Address - Street 2:STE #200
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-2610
Mailing Address - Country:US
Mailing Address - Phone:956-992-9100
Mailing Address - Fax:956-992-0410
Practice Address - Street 1:5801 N 10TH ST
Practice Address - Street 2:STE #200
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2610
Practice Address - Country:US
Practice Address - Phone:956-992-9100
Practice Address - Fax:956-992-0410
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6227TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171477601Medicaid
TX611512Medicare ID - Type Unspecified
U92422Medicare UPIN