Provider Demographics
NPI:1316399447
Name:MCKISSICK, APRIL LEIGH (OD)
Entity Type:Individual
Prefix:DR
First Name:APRIL
Middle Name:LEIGH
Last Name:MCKISSICK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:APRIL
Other - Middle Name:LEIGH
Other - Last Name:DUTTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:1906 GLENN BLVD SW STE 100-A
Mailing Address - Street 2:
Mailing Address - City:FORT PAYNE
Mailing Address - State:AL
Mailing Address - Zip Code:35968-3545
Mailing Address - Country:US
Mailing Address - Phone:256-845-5555
Mailing Address - Fax:256-997-9310
Practice Address - Street 1:1906 GLENN BLVD SW STE 100-A
Practice Address - Street 2:
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35968-3545
Practice Address - Country:US
Practice Address - Phone:256-845-5555
Practice Address - Fax:256-997-9310
Is Sole Proprietor?:No
Enumeration Date:2016-07-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-D53-TA-A57152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist