Provider Demographics
NPI:1588687032
Name:KIESLING, PAUL DANIEL (OD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:DANIEL
Last Name:KIESLING
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1163 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1383
Mailing Address - Country:US
Mailing Address - Phone:740-446-8584
Mailing Address - Fax:740-446-8685
Practice Address - Street 1:1163 JACKSON PIKE
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-1383
Practice Address - Country:US
Practice Address - Phone:740-446-8584
Practice Address - Fax:740-446-8685
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3475/T798152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0428862Medicaid
OH0428862Medicaid
OH0758490001Medicare NSC