Provider Demographics
NPI:1285659417
Name:KIRN, WILLIAM T (OD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:T
Last Name:KIRN
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 1:272 COTTAGE ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04073-1815
Mailing Address - Country:US
Mailing Address - Phone:207-324-8888
Mailing Address - Fax:
Practice Address - Street 1:272 COTTAGE ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:ME
Practice Address - Zip Code:04073-1815
Practice Address - Country:US
Practice Address - Phone:207-324-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT818152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME260530099Medicaid
U74240Medicare UPIN