Provider Demographics
NPI:1093406993
Name:SISK, AMBER LANONE (LDO)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:LANONE
Last Name:SISK
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 SYCAMORE ST SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-2506
Mailing Address - Country:US
Mailing Address - Phone:904-866-0645
Mailing Address - Fax:
Practice Address - Street 1:1100 OLD PHILADELPHIA RD
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-4045
Practice Address - Country:US
Practice Address - Phone:706-301-9100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALDO2822156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician