Provider Demographics
NPI:1649588708
Name:DE YOUNG, KIRK N (OD)
Entity Type:Individual
Prefix:DR
First Name:KIRK
Middle Name:N
Last Name:DE YOUNG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:967 CARDINAL CIR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-3013
Mailing Address - Country:US
Mailing Address - Phone:920-316-0616
Mailing Address - Fax:
Practice Address - Street 1:2701 DAVID H MCLEOD BLVD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-4043
Practice Address - Country:US
Practice Address - Phone:843-664-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-22
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3192-35152W00000X
SC1640152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist