Healthcare Provider Details

I. General information

NPI: 1275560179
Provider Name (Legal Business Name): KISSEL FAMILY OPTOMETRY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 MAIN AVE
PINEVILLE WV
24874-6001
US

IV. Provider business mailing address

PO BOX 1789
PINEVILLE WV
24874-1789
US

V. Phone/Fax

Practice location:
  • Phone: 304-732-6322
  • Fax: 304-732-8919
Mailing address:
  • Phone: 304-732-6322
  • Fax: 304-732-8919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberWV0944
License Number StateWV

VIII. Authorized Official

Name: DR. KEVIN TODD KISSEL
Title or Position: PRESIDENT
Credential: O.D.
Phone: 304-732-6322