Provider Demographics
NPI:1942213863
Name:REDMAN, KIRBY D (OD)
Entity Type:Individual
Prefix:
First Name:KIRBY
Middle Name:D
Last Name:REDMAN
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 1:9319 TIMBERLINE DR
Mailing Address - Street 2:
Mailing Address - City:MINOCQUA
Mailing Address - State:WI
Mailing Address - Zip Code:54548
Mailing Address - Country:US
Mailing Address - Phone:715-356-7811
Mailing Address - Fax:715-356-2257
Practice Address - Street 1:1020 3RD AVE
Practice Address - Street 2:
Practice Address - City:WOODRUFF
Practice Address - State:WI
Practice Address - Zip Code:54568-1520
Practice Address - Country:US
Practice Address - Phone:715-356-2262
Practice Address - Fax:715-356-2257
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1759152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38512900Medicaid
WI38512900Medicaid