MEDICARE: DR. GULSAH KILIC 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
1	152W00000X	Optometrist	27OA00713500	NJ
2	152W00000X	Optometrist	OPC6186	FL

General Provider Information

NPI Number	:	1821720772
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GULSAH KILIC OD

Provider Business Mailing Address
First Line	:	3224 N POINCIANA BLVD
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34746-4688
Country	:	US
Telephone Number	:	407-861-5292
Fax Number	:

Provider Business Practice Location Address
First Line	:	3224 N POINCIANA BLVD
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34746-4688
Country	:	US
Telephone Number	:	407-861-5292
Fax Number	:

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

Provider Enumeration Date	:	06/29/2022
Last Update Date	:	11/15/2023

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