MEDICARE: DAVID H KISLING, O.D., P.C.

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	1133	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750578829
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID H KISLING, O.D., P.C.

Provider Business Mailing Address
First Line	:	181 W BOARDWALK DR
Second Line	:	#201
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-3069
Country	:	US
Telephone Number	:	970-226-0959
Fax Number	:	970-226-0962

Provider Business Practice Location Address
First Line	:	181 W BOARDWALK DR
Second Line	:	#201
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-3069
Country	:	US
Telephone Number	:	970-226-0959
Fax Number	:	970-226-0962

Authorized Official
Title or Position	:	OWNER
Name	:	DAVID H KISLING
Credential	:	O.D.
Telephone Number	:	970-226-0959

Provider Enumeration Date	:	10/02/2007
Last Update Date	:	10/02/2007

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