Provider Demographics
NPI:1992120752
Name:LISKE, RICHARD EDWARD
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:EDWARD
Last Name:LISKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2476 W STATE HIGHWAY 154
Mailing Address - Street 2:
Mailing Address - City:QUITMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75783-5587
Mailing Address - Country:US
Mailing Address - Phone:903-878-2451
Mailing Address - Fax:903-878-2933
Practice Address - Street 1:2476 W STATE HIGHWAY 154
Practice Address - Street 2:
Practice Address - City:QUITMAN
Practice Address - State:TX
Practice Address - Zip Code:75783-5587
Practice Address - Country:US
Practice Address - Phone:903-878-2451
Practice Address - Fax:903-878-2933
Is Sole Proprietor?:No
Enumeration Date:2014-03-03
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician