Provider Demographics
NPI:1275560179
Name:KISSEL FAMILY OPTOMETRY, INC.
Entity Type:Organization
Organization Name:KISSEL FAMILY OPTOMETRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:KISSEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:304-732-6322
Mailing Address - Street 1:PO BOX 1789
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:24874-1789
Mailing Address - Country:US
Mailing Address - Phone:304-732-6322
Mailing Address - Fax:304-732-8919
Practice Address - Street 1:100 MAIN ST.
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:WV
Practice Address - Zip Code:24874-1789
Practice Address - Country:US
Practice Address - Phone:304-732-6322
Practice Address - Fax:304-732-8919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV0944152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1323450001Medicare NSC
WV9308791Medicare PIN