Provider Demographics
NPI:1609043520
Name:WILLIAM KIERNAN,O.D., INC.
Entity Type:Organization
Organization Name:WILLIAM KIERNAN,O.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:HUGH
Authorized Official - Last Name:KIERNAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:760-564-2113
Mailing Address - Street 1:46660 WASHINGTON ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-2451
Mailing Address - Country:US
Mailing Address - Phone:760-564-2113
Mailing Address - Fax:
Practice Address - Street 1:46660 WASHINGTON ST
Practice Address - Street 2:SUITE 3
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-2451
Practice Address - Country:US
Practice Address - Phone:760-564-2113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7661T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty