Provider Demographics
NPI:1922090653
Name:KIESLING, M DEAN (OD)
Entity Type:Individual
Prefix:DR
First Name:M
Middle Name:DEAN
Last Name:KIESLING
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:PO BOX 280
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45133-0280
Mailing Address - Country:US
Mailing Address - Phone:937-393-2336
Mailing Address - Fax:937-393-2744
Practice Address - Street 1:180 CHILLICOTHE AVE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133-1570
Practice Address - Country:US
Practice Address - Phone:937-393-2336
Practice Address - Fax:937-393-2744
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3356/771152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0303490001Medicare NSC
OH31-1066697Medicare UPIN