Doctor Name: | MR. ALLAN MICHAEL KIESWETTER |
NPI Number: | 1336316124 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | OPTICIAN |
License Number: | 3272 |
Business Practice Address: | 55 Main St Massena, NY - 136621913 |
Business Phone Number: | 3157695881 |
Business Fax Number: | |
Mailing Address: | 55 Main St, MASSENA |
State: | NY |
Postal Code: | 136621913 |
Phone Number: | 3157695881 |
Fax Number: | |
NPI Enumeration Date: | 05/12/2008 |
NPI Last Update Date: | 05/12/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 156FX1800X |
License Number: | 3272 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Eye and Vision Services Providers |
Taxonomy Classification: | Technician/Technologist |
Taxonomy Specialization: | Optician |
Taxonomy Definition: |