Provider Demographics
NPI:1942281407
Name:KISLING, DAVID HILTON (OD)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:HILTON
Last Name:KISLING
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 1:181 W BOARDWALK DR
Mailing Address - Street 2:SUITE #201
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-3069
Mailing Address - Country:US
Mailing Address - Phone:970-226-0959
Mailing Address - Fax:970-226-0962
Practice Address - Street 1:181 W BOARDWALK DR
Practice Address - Street 2:SUITE #201
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3069
Practice Address - Country:US
Practice Address - Phone:970-226-0959
Practice Address - Fax:970-226-0962
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO113399152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO110319OtherEYEMED
CO79687831Medicaid
CO40343Medicare ID - Type Unspecified