Provider Demographics
NPI:1225134950
Name:STRAUSS - KISLIN, CARRIE BLAKE (OD)
Entity Type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:BLAKE
Last Name:STRAUSS - KISLIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 MORRIS AVE
Mailing Address - Street 2:STE 302
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-1224
Mailing Address - Country:US
Mailing Address - Phone:973-232-6900
Mailing Address - Fax:973-232-6911
Practice Address - Street 1:155 MORRIS AVE
Practice Address - Street 2:STE 302
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-1224
Practice Address - Country:US
Practice Address - Phone:973-232-6900
Practice Address - Fax:973-232-6911
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV 006802152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV02634Medicare UPIN
NJ223196R35Medicare UPIN