Provider Demographics
NPI:1043380181
Name:SAKS-KNESTRICT, LISA JENNIFER (OD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:JENNIFER
Last Name:SAKS-KNESTRICT
Suffix:
Gender:
Credentials:OD
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:JENNIFER
Other - Last Name:SAKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:6850 HOHMAN AVE
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46324-1410
Mailing Address - Country:US
Mailing Address - Phone:219-736-2200
Mailing Address - Fax:219-937-5094
Practice Address - Street 1:9797 MASSACHUSETTS ST
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-0278
Practice Address - Country:US
Practice Address - Phone:219-649-2704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003069152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200329720Medicaid
INP022745403Medicaid
IN0804610002Medicare NSC