MEDICARE: DR. ERIC ALEXANDER LISS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	0101288595	VA
2	207W00000X	Ophthalmology Physician	ME132169	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	PH823	OTHER	FL	PTAN
3	OD205	OTHER	FL	PTAN
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225477748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC ALEXANDER LISS M.D.

Provider Business Mailing Address
First Line	:	17 N MEDICAL PARK DR
Second Line	:
City	:	FISHERSVILLE
State	:	VA
Zip	:	22939-2344
Country	:	US
Telephone Number	:	540-213-7720
Fax Number	:

Provider Business Practice Location Address
First Line	:	62 HILL TOP LN
Second Line	:
City	:	LEXINGTON
State	:	VA
Zip	:	24450-5726
Country	:	US
Telephone Number	:	540-463-4140
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2013
Last Update Date	:	04/29/2026

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