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NPI Code Detail

MEDICARE: DR. KEVIN C BISTLINE O.D.

MEDICARE:  DR. KEVIN C BISTLINE  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
1152W00000XOptometristOEG002052PA

General Provider Information

NPI Number : 1538311600
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KEVIN C BISTLINE O.D.
Provider Business Mailing Address
First Line : 32 E 4TH ST
Second Line :
City : LANSDALE
State : PA
Zip : 19446-2602
Country : US
Telephone Number : 267-218-5778
Fax Number :
Provider Business Practice Location Address
First Line : 500 W GERMANTOWN PIKE STE 2230
Second Line :
City : PLYMOUTH MEETING
State : PA
Zip : 19462-3304
Country : US
Telephone Number : 610-941-0335
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/21/2008
Last Update Date : 10/03/2018

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Directions to “ DR. KEVIN C BISTLINE O.D.” Practice Location

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