Provider Demographics
NPI:1598816167
Name:SAMUEL LOUIS KIRBY
Entity Type:Organization
Organization Name:SAMUEL LOUIS KIRBY
Other - Org Name:DRS KIRBY AND MCLAUGHLIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:KIRBY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:256-767-2344
Mailing Address - Street 1:174 ANA DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-1759
Mailing Address - Country:US
Mailing Address - Phone:256-767-2344
Mailing Address - Fax:
Practice Address - Street 1:174 ANA DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-1759
Practice Address - Country:US
Practice Address - Phone:256-767-2344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS450TA254152W00000X
ALS689TA255152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALU12421Medicare UPIN
AL000058292Medicare ID - Type Unspecified
ALT68958Medicare UPIN
AL000059769Medicare ID - Type Unspecified