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General NPI Number Information
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NPI Number | 1619065224
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Entity Type | Organization
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Legal Business Name | DAVID W. KISIOLEK, O.D., S.C.
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 11/11/2025
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Provider Practice Location Address
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Address Line | 300 AUDUBON RD
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City | HOWARDS GROVE
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State | WI
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Zip | 53083-1288
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Country | US
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Telephone | 920-565-3991
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Fax | 920-565-4404
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Provider Business Mailing Address
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Address Line | 300 AUDUBON RD
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City | HOWARDS GROVE
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State | WI
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Zip | 53083-1288
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Country | US
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Telephone | 920-565-3991
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Fax | 920-565-4404
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | DAVID W KISIOLEK
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Credential | OD
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Telephone | 920-565-3991
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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 | 1742
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License Number State | WI
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