MEDICARE: JENNY M. KISNER OD LLC

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	207W00000X	Ophthalmology Physician
2	152W00000X	Optometrist

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	:	1891938163
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JENNY M. KISNER OD LLC

Provider Business Mailing Address
First Line	:	1508 BROOK AVE
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76301-5604
Country	:	US
Telephone Number	:	940-761-2317
Fax Number	:	940-761-2992

Provider Business Practice Location Address
First Line	:	1508 BROOK AVE
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76301-5604
Country	:	US
Telephone Number	:	940-761-2317
Fax Number	:	940-761-2992

Authorized Official
Title or Position	:	OWNER/MEMBER
Name	:	JENNY M KISNER
Credential	:	O.D.
Telephone Number	:	940-761-2317

Provider Enumeration Date	:	04/15/2009
Last Update Date	:	03/25/2025

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