Provider Demographics
NPI:1841381860
Name:KIRWAN, STEPHEN JOHN (OD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:JOHN
Last Name:KIRWAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1196
Mailing Address - Street 2:36 CENTER ST. #5
Mailing Address - City:WOLFEBORO FALLS
Mailing Address - State:NH
Mailing Address - Zip Code:03896-1196
Mailing Address - Country:US
Mailing Address - Phone:603-569-8500
Mailing Address - Fax:603-569-8905
Practice Address - Street 1:36 CENTER ST # 5
Practice Address - Street 2:
Practice Address - City:WOLFEBORO
Practice Address - State:NH
Practice Address - Zip Code:03894-4324
Practice Address - Country:US
Practice Address - Phone:603-569-8500
Practice Address - Fax:603-569-8905
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0686152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0686OtherSTATE LICENSE NUMBER
NH09Y002591NH01OtherBC/BS
4993990001OtherDMERC REGION A
NH0686OtherSTATE LICENSE NUMBER
NHRE5535Medicare ID - Type Unspecified