Provider Demographics
NPI:1942477351
Name:LANDON L. LISKA ENTERPRISES, P.C.
Entity type:Organization
Organization Name:LANDON L. LISKA ENTERPRISES, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LANDON
Authorized Official - Middle Name:L
Authorized Official - Last Name:LISKA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:956-992-9100
Mailing Address - Street 1:5801 N 10TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-2601
Mailing Address - Country:US
Mailing Address - Phone:956-992-9100
Mailing Address - Fax:956-992-0410
Practice Address - Street 1:5801 N 10TH ST STE 200
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2601
Practice Address - Country:US
Practice Address - Phone:956-992-9100
Practice Address - Fax:956-992-0410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX06227152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1396745998OtherNPI
TX171477601Medicaid
TX1396745998OtherNPI
TX611512Medicare PIN