Provider Demographics
NPI:1437358959
Name:KIRBY, JOHN ALLEN (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALLEN
Last Name:KIRBY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:12904 LEBANON RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-2865
Mailing Address - Country:US
Mailing Address - Phone:615-773-2212
Mailing Address - Fax:615-754-2870
Practice Address - Street 1:12904 LEBANON RD
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-2865
Practice Address - Country:US
Practice Address - Phone:615-450-0050
Practice Address - Fax:615-450-0044
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-14
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN2759152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist