Provider Demographics
NPI:1770810681
Name:KISSEL VILLAGE EYE CARE
Entity type:Organization
Organization Name:KISSEL VILLAGE EYE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:E
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:717-625-4989
Mailing Address - Street 1:1026 LITITZ PIKE
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-9328
Mailing Address - Country:US
Mailing Address - Phone:717-625-4989
Mailing Address - Fax:717-625-7360
Practice Address - Street 1:1026 LITITZ PIKE
Practice Address - Street 2:
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-9328
Practice Address - Country:US
Practice Address - Phone:717-625-4989
Practice Address - Fax:717-625-7360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-13
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001123332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA4611800001Medicare NSC
PA234036Medicare PIN