Provider Demographics
NPI:1396825014
Name:KIERNAN, CYNTHIA (OD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:
Last Name:KIERNAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7732 ROYAL OAKS RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-2017
Mailing Address - Country:US
Mailing Address - Phone:702-614-5435
Mailing Address - Fax:702-614-5426
Practice Address - Street 1:2310 E SERENE AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-3248
Practice Address - Country:US
Practice Address - Phone:702-614-5435
Practice Address - Fax:702-614-5426
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV357152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100507543Medicaid
NV100507543Medicaid
NVU69725Medicare UPIN