Provider Demographics
NPI:1336331768
Name:KIRKLAND, THOMAS W JR (LICENSED OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:W
Last Name:KIRKLAND
Suffix:JR
Gender:M
Credentials:LICENSED OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23219-3302
Mailing Address - Country:US
Mailing Address - Phone:804-783-1500
Mailing Address - Fax:804-783-1512
Practice Address - Street 1:24 N 8TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23219-3302
Practice Address - Country:US
Practice Address - Phone:804-783-1500
Practice Address - Fax:804-783-1512
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA817156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004179OtherANTHEM BLUE CROSS AND BLU