Provider Demographics
NPI:1952371122
Name:KISSEL, JOY HOVICK (OD)
Entity Type:Individual
Prefix:DR
First Name:JOY
Middle Name:HOVICK
Last Name:KISSEL
Suffix:
Gender:F
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 585
Mailing Address - Street 2:
Mailing Address - City:OCEANA
Mailing Address - State:WV
Mailing Address - Zip Code:24870-0585
Mailing Address - Country:US
Mailing Address - Phone:304-682-6144
Mailing Address - Fax:
Practice Address - Street 1:100 COOK PARKWAY
Practice Address - Street 2:
Practice Address - City:OCEANA
Practice Address - State:WV
Practice Address - Zip Code:24870-0585
Practice Address - Country:US
Practice Address - Phone:304-682-6144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV0944152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3104013000Medicaid
WVU68602Medicare UPIN
WV3104013000Medicaid