MEDICARE: DR. THOMAS P KISLAN O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OEG000090	PA

General Provider Information

NPI Number	:	1255319646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS P KISLAN O.D.

Provider Business Mailing Address
First Line	:	852 N 9TH ST
Second Line	:
City	:	STROUDSBURG
State	:	PA
Zip	:	18360-1206
Country	:	US
Telephone Number	:	570-421-3342
Fax Number	:	570-421-8490

Provider Business Practice Location Address
First Line	:	852 N 9TH ST
Second Line	:
City	:	STROUDSBURG
State	:	PA
Zip	:	18360-1206
Country	:	US
Telephone Number	:	570-421-3342
Fax Number	:	570-421-8490

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2006
Last Update Date	:	03/04/2011

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