Provider Demographics
NPI:1114142148
Name:KIRSCHNER OPTOMETRIC ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:KIRSCHNER OPTOMETRIC ASSOCIATES, P.C.
Other - Org Name:KIRSCHNER VISION GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRSCHNER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:708-957-7700
Mailing Address - Street 1:2156 183RD ST
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-3238
Mailing Address - Country:US
Mailing Address - Phone:708-957-7700
Mailing Address - Fax:708-957-7715
Practice Address - Street 1:2156 183RD ST
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-3238
Practice Address - Country:US
Practice Address - Phone:708-957-7700
Practice Address - Fax:708-957-7715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCH3612OtherRAILROAD MEDICARE
IL01684444OtherBLUE CROSS BLUE SHIELD
IL507170Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER