Individual
DR. KATRINA RENEE LIESKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
5412 BOAT CLUB RD STE 150, FORT WORTH, TX 76135-1205
(817) 546-9000
Mailing address
5412 BOAT CLUB RD STE 150, FORT WORTH, TX 76135-1205
(817) 546-9000
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
5578TG
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0030FG
BCBS PROVIDER #
TX
Enumeration date
10/21/2005
Last updated
12/28/2021
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