Provider Demographics
NPI:1821138413
Name:FLEMING KIRK, LLC
Entity Type:Organization
Organization Name:FLEMING KIRK, LLC
Other - Org Name:TROY EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNA
Authorized Official - Middle Name:FLEMING
Authorized Official - Last Name:KIRK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:334-403-0627
Mailing Address - Street 1:97 OAK PARK DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:AL
Mailing Address - Zip Code:36079-3081
Mailing Address - Country:US
Mailing Address - Phone:334-566-7172
Mailing Address - Fax:
Practice Address - Street 1:97 OAK PARK DRIVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:AL
Practice Address - Zip Code:36079
Practice Address - Country:US
Practice Address - Phone:334-403-0627
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS853TA409152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1487622932OtherINDIV NPI
ALU697367Medicare UPIN