Provider Demographics
NPI:1508165242
Name:KIRK OPTOMETRY, LLC
Entity Type:Organization
Organization Name:KIRK OPTOMETRY, LLC
Other - Org Name:TARA KIRK, OD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TARA
Authorized Official - Middle Name:JOANNE WEISBECK
Authorized Official - Last Name:KIRK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:804-301-1969
Mailing Address - Street 1:567 CREEKSIDE LN
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-6813
Mailing Address - Country:US
Mailing Address - Phone:804-301-1969
Mailing Address - Fax:717-757-2350
Practice Address - Street 1:2899 WHITEFORD RD
Practice Address - Street 2:BOSCOV'S OPTICAL DEPARTMENT
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-8902
Practice Address - Country:US
Practice Address - Phone:717-755-4395
Practice Address - Fax:717-757-2350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002194261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center