Provider Demographics
NPI:1477842508
Name:SHAHANE T. KIRMAN OD AND ASSOCIATE
Entity Type:Organization
Organization Name:SHAHANE T. KIRMAN OD AND ASSOCIATE
Other - Org Name:KIRMAN EYE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GROUP OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:S
Authorized Official - Last Name:KIRMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:717-566-3216
Mailing Address - Street 1:29 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HUMMELSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17036-1538
Mailing Address - Country:US
Mailing Address - Phone:717-566-3216
Mailing Address - Fax:717-256-0030
Practice Address - Street 1:29 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HUMMELSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17036-1538
Practice Address - Country:US
Practice Address - Phone:717-566-3216
Practice Address - Fax:717-256-0030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000924332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU57487Medicare UPIN
PAT30716Medicare UPIN