MEDICARE: MR. DAVID HILTON KISLING 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
1	152W00000X	Optometrist	113399	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110319	OTHER	CO	EYEMED
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942281407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID HILTON KISLING O.D.

Provider Business Mailing Address
First Line	:	181 W BOARDWALK DR
Second Line	:	SUITE #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	:	SUITE #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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	07/09/2007

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