Provider Demographics
NPI:1679793749
Name:KIRSHNER, BRUCE S (OD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:S
Last Name:KIRSHNER
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 1:21 N DAWES AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704
Mailing Address - Country:US
Mailing Address - Phone:570-762-3582
Mailing Address - Fax:
Practice Address - Street 1:441 WILKES BORRE TWP BLVD
Practice Address - Street 2:SAMS CLUB OPTICAL
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702
Practice Address - Country:US
Practice Address - Phone:570-821-5513
Practice Address - Fax:570-821-5514
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE005125T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist