Provider Demographics
NPI:1659497923
Name:CYNTHIA KIERNAN OD, INC
Entity Type:Organization
Organization Name:CYNTHIA KIERNAN OD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KIERNAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:702-614-5435
Mailing Address - Street 1:7732 ROYAL OAKS RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-2017
Mailing Address - Country:US
Mailing Address - Phone:702-614-5435
Mailing Address - Fax:702-614-5426
Practice Address - Street 1:2310 E SERENE AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-3248
Practice Address - Country:US
Practice Address - Phone:702-614-5435
Practice Address - Fax:702-614-5426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100507543Medicaid
NV100507543Medicaid