Provider Demographics
NPI:1265484737
Name:KIRBY, THOMAS R (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:R
Last Name:KIRBY
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 1:2183 JAMES B WHITE HWY N
Mailing Address - Street 2:
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-8989
Mailing Address - Country:US
Mailing Address - Phone:910-641-0011
Mailing Address - Fax:910-641-0083
Practice Address - Street 1:2183 JAMES B WHITE HWY N
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-8989
Practice Address - Country:US
Practice Address - Phone:910-641-0011
Practice Address - Fax:910-641-0083
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1548152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890913PMedicaid
NC890913PMedicaid
NC2469427DMedicare PIN