Provider Demographics
NPI:1720086663
Name:ZISKROUT, DANA CRAIG (OD)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:CRAIG
Last Name:ZISKROUT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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 1:20811 HIGHWAY 59 N STE 300
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-2260
Practice Address - Country:US
Practice Address - Phone:281-446-2020
Practice Address - Fax:281-548-3411
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5477TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX041996205Medicaid
TX041996204Medicaid
TX8664B7Medicare UPIN
P00274447Medicare PIN
TX83347EMedicare ID - Type Unspecified
TX041996204Medicaid
TX8D6930Medicare ID - Type UnspecifiedBERKELEY EYE CENTER
TXTXB106810Medicare PIN