Provider Demographics
NPI:1376516963
Name:KIRK, THOMAS EARL (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:EARL
Last Name:KIRK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 COLLEGE AVENUE
Mailing Address - Street 2:SUITE D156
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-2769
Mailing Address - Country:US
Mailing Address - Phone:785-776-0450
Mailing Address - Fax:785-537-9504
Practice Address - Street 1:1133 COLLEGE AVENUE
Practice Address - Street 2:SUITE D156
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-2769
Practice Address - Country:US
Practice Address - Phone:785-776-0450
Practice Address - Fax:785-537-9504
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0416502207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS001585Medicare ID - Type Unspecified
B68556Medicare UPIN