MEDICARE: DR. CARRIE BLAKE STRAUSS - KISLIN O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	TUV 006802	NY

General Provider Information

NPI Number	:	1225134950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARRIE BLAKE STRAUSS - KISLIN O.D.

Provider Business Mailing Address
First Line	:	155 MORRIS AVE
Second Line	:	STE 302
City	:	SPRINGFIELD
State	:	NJ
Zip	:	07081-1224
Country	:	US
Telephone Number	:	973-232-6900
Fax Number	:	973-232-6911

Provider Business Practice Location Address
First Line	:	155 MORRIS AVE
Second Line	:	STE 302
City	:	SPRINGFIELD
State	:	NJ
Zip	:	07081-1224
Country	:	US
Telephone Number	:	973-232-6900
Fax Number	:	973-232-6911

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	06/20/2016

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