Provider Demographics
NPI:1831321884
Name:KIRK, TARA JOANNE WEISBECK (OD)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:JOANNE WEISBECK
Last Name:KIRK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:JOANNE
Other - Last Name:WEISBECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1671 JOFFRE RD
Mailing Address - Street 2:
Mailing Address - City:FORKED RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08731-3406
Mailing Address - Country:US
Mailing Address - Phone:609-891-8503
Mailing Address - Fax:
Practice Address - Street 1:442 LACEY RD
Practice Address - Street 2:SUITE #3
Practice Address - City:FORKED RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08731-2436
Practice Address - Country:US
Practice Address - Phone:609-891-8503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-10
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002194152W00000X
NJ27OA00638600152W00000X
NJ27OM00111100152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist