Provider Demographics
NPI:1831243484
Name:ZILIAK, LISA KISH (OD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:KISH
Last Name:ZILIAK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:LEE
Other - Last Name:KISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2101 16TH ST NW
Mailing Address - Street 2:APT 420
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-6502
Mailing Address - Country:US
Mailing Address - Phone:202-536-2755
Mailing Address - Fax:
Practice Address - Street 1:6900 GEORGIA AVE NW
Practice Address - Street 2:HEATON PAVILION (BLDG 2), WARD 74
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20307-0003
Practice Address - Country:US
Practice Address - Phone:202-782-4955
Practice Address - Fax:202-782-4913
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist