Provider Demographics
NPI:1346242377
Name:KIRKS, JAMES MATTHEW (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MATTHEW
Last Name:KIRKS
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 1:108 BREVCO PLZ
Mailing Address - Street 2:
Mailing Address - City:LAKE SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-1399
Mailing Address - Country:US
Mailing Address - Phone:636-561-6000
Mailing Address - Fax:636-625-0707
Practice Address - Street 1:108 BREVCO PLZ
Practice Address - Street 2:
Practice Address - City:LAKE SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-1399
Practice Address - Country:US
Practice Address - Phone:636-561-6000
Practice Address - Fax:636-625-0707
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOTO3342152W00000X, 152WC0802X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO318844016Medicaid
MOU66874Medicare UPIN
MO318844016Medicaid