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General NPI Number Information
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NPI Number | 1366503708
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Entity Type | Individual
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Provider Name | DOUGLAS KIESSLING OD
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Gender | Male
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 14139 POTOMAC MILLS ROAD
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City | WOODBRIDGE
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State | VA
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Zip | 20192-4644
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Country | US
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Telephone | 703-490-7606
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Fax | 703-490-7824
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Provider Business Mailing Address
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Address Line | 2101 EAST JEFFERSON STREET PPQA MEDICARE COMPLIANCE UNIT 6W ATTN THERESA BROOKS
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City | ROCKVILLE
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State | MD
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Zip | 20852-4908
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Country | US
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Telephone | 301-816-6660
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Fax | 301-816-6308
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 0618000219
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 0601000665
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OP399
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License Number State | DC
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