Provider Demographics
NPI:1518579671
Name:DRS SANDRA M KROKOS & THOMAS P KISLAN PC
Entity Type:Organization
Organization Name:DRS SANDRA M KROKOS & THOMAS P KISLAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:P
Authorized Official - Last Name:KISLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-421-3342
Mailing Address - Street 1:541 W BACON ST
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-3917
Mailing Address - Country:US
Mailing Address - Phone:570-421-3342
Mailing Address - Fax:
Practice Address - Street 1:541 W BACON ST
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-3917
Practice Address - Country:US
Practice Address - Phone:570-421-3342
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty