Provider Demographics
NPI:1376545442
Name:HEARNE, KIRK A (OD)
Entity Type:Individual
Prefix:DR
First Name:KIRK
Middle Name:A
Last Name:HEARNE
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 1:865 W COUNTY ROAD 60 S
Mailing Address - Street 2:
Mailing Address - City:NORTH VERNON
Mailing Address - State:IN
Mailing Address - Zip Code:47265-4832
Mailing Address - Country:US
Mailing Address - Phone:812-346-5556
Mailing Address - Fax:
Practice Address - Street 1:130 N STATE ST
Practice Address - Street 2:
Practice Address - City:NORTH VERNON
Practice Address - State:IN
Practice Address - Zip Code:47265-1724
Practice Address - Country:US
Practice Address - Phone:812-346-4646
Practice Address - Fax:812-352-6262
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-02
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002748B152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000087936OtherANTHEM
IN200050860Medicaid
IN200050860Medicaid
IN160660BMedicare ID - Type Unspecified
IN0430000001Medicare NSC