MEDICARE: DR. APRIL LEIGH MCKISSICK 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	S-D53-TA-A57	AL

General Provider Information

NPI Number	:	1316399447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. APRIL LEIGH MCKISSICK O.D

Provider Business Mailing Address
First Line	:	1906 GLENN BLVD SW STE 100-A
Second Line	:
City	:	FORT PAYNE
State	:	AL
Zip	:	35968-3545
Country	:	US
Telephone Number	:	256-845-5555
Fax Number	:	256-997-9310

Provider Business Practice Location Address
First Line	:	1906 GLENN BLVD SW STE 100-A
Second Line	:
City	:	FORT PAYNE
State	:	AL
Zip	:	35968-3545
Country	:	US
Telephone Number	:	256-845-5555
Fax Number	:	256-997-9310

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

Provider Enumeration Date	:	07/13/2016
Last Update Date	:	07/21/2022

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