Provider Demographics
NPI:1538311600
Name:BISTLINE, KEVIN C (OD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:C
Last Name:BISTLINE
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 1:32 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-2602
Mailing Address - Country:US
Mailing Address - Phone:267-218-5778
Mailing Address - Fax:
Practice Address - Street 1:500 W GERMANTOWN PIKE STE 2230
Practice Address - Street 2:
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-3304
Practice Address - Country:US
Practice Address - Phone:610-941-0335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002052152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist