Provider Demographics
NPI:1992905863
Name:LISAK, JANET ANN (OPHTHALMIC DISPENSER)
Entity type:Individual
Prefix:MRS
First Name:JANET
Middle Name:ANN
Last Name:LISAK
Suffix:
Gender:F
Credentials:OPHTHALMIC DISPENSER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 WINSTON DR
Mailing Address - Street 2:
Mailing Address - City:ENDWELL
Mailing Address - State:NY
Mailing Address - Zip Code:13760-2427
Mailing Address - Country:US
Mailing Address - Phone:607-237-3746
Mailing Address - Fax:607-798-8344
Practice Address - Street 1:527 WINSTON DR
Practice Address - Street 2:
Practice Address - City:ENDWELL
Practice Address - State:NY
Practice Address - Zip Code:13760-2427
Practice Address - Country:US
Practice Address - Phone:607-237-3746
Practice Address - Fax:607-798-8344
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006184-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician