Provider Demographics
NPI:1790392587
Name:RISSER, ADRIANA C (OD)
Entity Type:Individual
Prefix:
First Name:ADRIANA
Middle Name:C
Last Name:RISSER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ADRIANA
Other - Middle Name:CASILLAS
Other - Last Name:CASILLAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:4740 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-2247
Practice Address - Country:US
Practice Address - Phone:773-275-2900
Practice Address - Fax:773-275-1307
Is Sole Proprietor?:No
Enumeration Date:2020-09-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046011477152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist