Provider Demographics
NPI:1760589386
Name:KIRSHNER, GARY DAVID (OD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:DAVID
Last Name:KIRSHNER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 W. DEKALB PK
Mailing Address - Street 2:SUITE #2011
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406
Mailing Address - Country:US
Mailing Address - Phone:610-265-3800
Mailing Address - Fax:
Practice Address - Street 1:690 W DEKALB PIKE
Practice Address - Street 2:SUITE #2011
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-2982
Practice Address - Country:US
Practice Address - Phone:610-265-3800
Practice Address - Fax:610-265-0412
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE005663T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA172374Medicare PIN