Provider Demographics
NPI:1881673184
Name:KISELOW, MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:KISELOW
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 1:909 MANHATTAN AVE
Mailing Address - Street 2:GREENPOINT EYE CARE LLC
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-5960
Mailing Address - Country:US
Mailing Address - Phone:718-389-0333
Mailing Address - Fax:718-389-0040
Practice Address - Street 1:909 MANHATTAN AVE
Practice Address - Street 2:GREENPOINT EYE CARE LLC
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-5960
Practice Address - Country:US
Practice Address - Phone:718-389-0333
Practice Address - Fax:718-389-0040
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006648-1152WC0802X
CA12450152WC0802X
FLOPC 4148152WC0802X
AZ1346152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02896642OtherMEDICAID
1881673184OtherVSP
1881673184OtherELDER PLAN
383511POtherHIP
00002813319-01OtherUNITED HEALTH CARE
330816OtherNVA
47175OtherSPECTERA
108OtherVISION SCREENING
1881673184OtherUNICARE
2585193OtherCIGNA
47175OtherOPTUM HEALTH
57117OtherHEALTH FIRST
57117OtherNEIGHBOORHOOD
IE0069OtherEYE QUEST VISION
000551510101OtherHEALTH PLUS
0135527OtherEMBLEM HEALTH
1881673184OtherBRICKLAYERS
57117OtherDAVIS VISION
57117OtherNY PRESBYTERIAN
1881673184OtherMULTIPLAN
57117OtherCSEA
7457515OtherAETNA
C399G2OtherBLUE CROSS BLUE SHIELD
P3814314OtherOXFORD
1881673184OtherROOFERS WATERPROOFERS
2585193OtherGREAT WEST
6C1614OtherHEALTH NET
936231OtherAMERIGROUP
953NOtherNATIONAL OPTICAL SERVICE
P0T00648OtherMETRO PLUS
1602400OtherCOVENTRY
1881673184OtherSUPERIOR VISION
NY214775OtherEYEMED
39079OtherMES VISION
57117OtherFIDELIS
936231OtherBLOCKVISION
IE0069OtherDORAL VISION
1602400OtherFIRST HEALTH
1881673184OtherPHCS
47734OtherAVESIS
C399G1OtherMEDICARE
C399G1OtherMEDICARE