Lieske, Katrina Renee
Lieske, Katrina Renee is an individual health care provider with primary practice located at 5412 Boat Club Rd Ste 150 , Fort Worth TX 76135-1205. She recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as her primary health care specialty. Lieske, Katrina Renee can be contacted via phone (817) 546-9000.Contact Information
Primary practice address
5412 Boat Club Rd Ste 150
Fort Worth TX 76135-1205
Phone: (817) 546-9000
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 5578TG | Texas |
Profile Details
| NPI number | 1477542470 |
|---|---|
| LBN Legal business name | Lieske, Katrina Renee |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 21st, 2005 |
| Last updated | Dec 28th, 2021 - about 5 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1477542470 | NPPES |
| Texas | Other | 0030FG | BCBS PROVIDER # |
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