Provider Demographics
NPI:1083979181
Name:KIRK, CARTER N (MD)
Entity Type:Individual
Prefix:DR
First Name:CARTER
Middle Name:N
Last Name:KIRK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CARTER
Other - Middle Name:NELSON
Other - Last Name:KIRK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:7427 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305-1817
Mailing Address - Country:US
Mailing Address - Phone:708-771-3334
Mailing Address - Fax:708-771-0841
Practice Address - Street 1:7427 LAKE ST
Practice Address - Street 2:
Practice Address - City:RIVER FOREST
Practice Address - State:IL
Practice Address - Zip Code:60305-1817
Practice Address - Country:US
Practice Address - Phone:708-771-3334
Practice Address - Fax:708-771-0841
Is Sole Proprietor?:No
Enumeration Date:2012-07-05
Last Update Date:2018-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036142203207WX0120X
GA075709207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Yes207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases Specialist