Provider Demographics
NPI:1033161450
Name:KIRSTEIN, MARK D (OD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:D
Last Name:KIRSTEIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:50 STANIFORD ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2517
Mailing Address - Country:US
Mailing Address - Phone:617-367-4800
Mailing Address - Fax:617-723-7028
Practice Address - Street 1:50 STANIFORD ST
Practice Address - Street 2:SUITE 600
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2517
Practice Address - Country:US
Practice Address - Phone:617-367-4800
Practice Address - Fax:617-723-7028
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA4071152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
004071OtherTUFTS HEALTH PLAN
152390OtherHARVARD PILGRIM HEALTH CA
MA110014781AMedicaid
MAW16266OtherBLUE CROSS BLUE SHIELD
MAW1735701Medicare PIN
T32066Medicare UPIN
MAQX9935Medicare PIN
MAW1735702Medicare PIN