Provider Demographics
NPI:1285180562
Name:KALISTOOK, ISAAC THOMAS (OD)
Entity Type:Individual
Prefix:
First Name:ISAAC
Middle Name:THOMAS
Last Name:KALISTOOK
Suffix:
Gender:M
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:PO BOX 941
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:AK
Mailing Address - Zip Code:99559-0941
Mailing Address - Country:US
Mailing Address - Phone:907-545-5138
Mailing Address - Fax:
Practice Address - Street 1:900 CHIEF EDDIE HOFFMAN HWY
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:AK
Practice Address - Zip Code:99559-0287
Practice Address - Country:US
Practice Address - Phone:907-543-6336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK113578152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist