Provider Demographics
NPI:1982713012
Name:KISCH, JOSEPH J (OD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:J
Last Name:KISCH
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 1:706 12TH ST SE
Mailing Address - Street 2:
Mailing Address - City:BARNESVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56514-3960
Mailing Address - Country:US
Mailing Address - Phone:218-354-7065
Mailing Address - Fax:
Practice Address - Street 1:512 ATLANTIC AVE
Practice Address - Street 2:MIDWEST FAMILY EYECARE LTD
Practice Address - City:MORRIS
Practice Address - State:MN
Practice Address - Zip Code:56267
Practice Address - Country:US
Practice Address - Phone:320-589-1300
Practice Address - Fax:320-589-3348
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2315152W00000X
ND489152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2202045OtherMEDICA
MN283R5K1OtherBCBS
MN36B55KIOtherBCBS
MN2202002OtherMEDICA
MN2202044OtherMEDICA
MN990325900Medicaid
MN077LAKIOtherBCBS
MN283R4K1OtherBCBS
MN2207651OtherMEDICA
MN2207651OtherMEDICA
MN410001203Medicare ID - Type Unspecified
MN077LAKIOtherBCBS
MN283R5K1OtherBCBS
MN410001954Medicare ID - Type Unspecified