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General NPI Number Information
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NPI Number | 1881673184
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Entity Type | Individual
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Provider Name | MICHAEL KISELOW O.D.
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Gender | Male
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Dates
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Enumeration Date | 01/13/2006
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Last Update Date | 06/28/2011
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Provider Practice Location Address
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Address Line | 909 MANHATTAN AVE GREENPOINT EYE CARE LLC
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City | BROOKLYN
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State | NY
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Zip | 11222-5960
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Country | US
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Telephone | 718-389-0333
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Fax | 718-389-0040
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Provider Business Mailing Address
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Address Line | 909 MANHATTAN AVE GREENPOINT EYE CARE LLC
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City | BROOKLYN
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State | NY
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Zip | 11222-5960
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Country | US
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Telephone | 718-389-0333
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Fax | 718-389-0040
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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 | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | TUV006648-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 12450
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | OPC 4148
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 1346
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License Number State | AZ
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