Provider Demographics
NPI:1629127436
Name:KIRSCHNER, KEVIN ATWOOD
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:ATWOOD
Last Name:KIRSCHNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 S LINCOLN AVE STE 104 PMB 383
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-3136
Mailing Address - Country:US
Mailing Address - Phone:951-735-6285
Mailing Address - Fax:951-735-8239
Practice Address - Street 1:750 S LINCOLN AVE STE 104 PMB 383
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-3136
Practice Address - Country:US
Practice Address - Phone:951-735-6285
Practice Address - Fax:951-735-8239
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1101XEye and Vision Services ProvidersTechnician/TechnologistOphthalmic Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATG009Medicare UPIN