Healthcare Provider Details

I. General information

NPI: 1245646561
Provider Name (Legal Business Name): RACHEL FRITZ KISHEL OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2014
Last Update Date: 01/07/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 JPM RD
LEWISBURG PA
17837-9313
US

IV. Provider business mailing address

88 HARDEES DR
MIFFLINBURG PA
17844-7062
US

V. Phone/Fax

Practice location:
  • Phone: 866-995-3937
  • Fax:
Mailing address:
  • Phone: 570-966-5582
  • Fax: 570-966-5586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG002941
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: