MEDICARE: DR. PHILIP GALE KIES 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	1251DT	KY
2	152W00000X	Optometrist	4331/T1024	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508819244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILIP GALE KIES O.D.

Provider Business Mailing Address
First Line	:	4452 EASTGATE BLVD
Second Line	:	SUITE 305
City	:	CINCINNATI
State	:	OH
Zip	:	45245-1584
Country	:	US
Telephone Number	:	513-752-5700
Fax Number	:	513-752-5716

Provider Business Practice Location Address
First Line	:	4452 EASTGATE BLVD
Second Line	:	SUITE 305
City	:	CINCINNATI
State	:	OH
Zip	:	45245-1584
Country	:	US
Telephone Number	:	513-752-5700
Fax Number	:	513-752-5716

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

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	04/05/2018

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Directions to “ DR. PHILIP GALE KIES O.D.” Practice Location

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