Provider Demographics
NPI:1760426928
Name:KIRBY, BROOKE S (OD, PHD)
Entity Type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:S
Last Name:KIRBY
Suffix:
Gender:F
Credentials:OD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3350 LA JOLLA VILLAGE DR
Mailing Address - Street 2:VA SAN DIEGO HEALTHCARE SYSTEM (112G)
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92161-0002
Mailing Address - Country:US
Mailing Address - Phone:858-552-8585
Mailing Address - Fax:858-642-3342
Practice Address - Street 1:3350 LA JOLLA VILLAGE DR
Practice Address - Street 2:VA SAN DIEGO HEALTHCARE SYSTEM (112G)
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92161-0002
Practice Address - Country:US
Practice Address - Phone:858-552-8585
Practice Address - Fax:858-642-3342
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9020152W00000X
WA3327152W00000X
TX4106T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist