Provider Demographics
NPI:1821048141
Name:KIRSCHEN, DAVID G (OD, PHD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:G
Last Name:KIRSCHEN
Suffix:
Gender:M
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 1:428 S BREA BLVD
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-5301
Mailing Address - Country:US
Mailing Address - Phone:714-529-2470
Mailing Address - Fax:
Practice Address - Street 1:428 S BREA BLVD
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-5301
Practice Address - Country:US
Practice Address - Phone:714-529-2470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOP5418T152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0054183Medicaid
CASD0054183Medicaid
CAWOP5418CMedicare PIN