Provider Demographics
NPI:1699947085
Name:DR SANDRA M KROKOS & THOMAS P KISLAN PC
Entity type:Organization
Organization Name:DR SANDRA M KROKOS & THOMAS P KISLAN PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:P
Authorized Official - Last Name:KISLAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:570-453-2020
Mailing Address - Street 1:281 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:HAZLE TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18202-3320
Mailing Address - Country:US
Mailing Address - Phone:570-453-2020
Mailing Address - Fax:570-453-1020
Practice Address - Street 1:281 AIRPORT ROAD
Practice Address - Street 2:
Practice Address - City:HAZLE TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18202
Practice Address - Country:US
Practice Address - Phone:570-453-2020
Practice Address - Fax:570-453-1020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE-000090152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA4442190001Medicare NSC
PA056753Medicare PIN