Provider Demographics
NPI:1437148756
Name:KRISEL, JAMES (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:KRISEL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:JAMES
Other - Middle Name:
Other - Last Name:KRISEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:6795 STIRLING RD
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-7118
Mailing Address - Country:US
Mailing Address - Phone:954-961-1509
Mailing Address - Fax:954-961-1604
Practice Address - Street 1:6795 STIRLING RD
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-7118
Practice Address - Country:US
Practice Address - Phone:954-961-1509
Practice Address - Fax:954-961-1604
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-19
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 954152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOS-D0626OtherBC/BS
FL084184600Medicaid
FL084184600Medicaid
FL19211Medicare ID - Type Unspecified