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NPI Code Detail

MEDICARE: DR. ROBERT JOHN KISH OD

MEDICARE: DR. ROBERT JOHN KISH OD
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
1152WC0802XCorneal and Contact Management Optometrist797CT

General Provider Information

NPI Number : 1578568770
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROBERT JOHN KISH OD
Provider Business Mailing Address
First Line : 748 LONG HILL RD
Second Line :
City : GROTON
State : CT
Zip : 06340-4273
Country : US
Telephone Number : 860-448-3937
Fax Number : 860-449-0343
Provider Business Practice Location Address
First Line : 748 LONG HILL RD
Second Line :
City : GROTON
State : CT
Zip : 06340-4273
Country : US
Telephone Number : 860-448-3937
Fax Number : 860-449-0343
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2005
Last Update Date : 07/08/2007

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