Provider Demographics
NPI:1700069457
Name:KIRBY EYE CENTER, PA
Entity Type:Organization
Organization Name:KIRBY EYE CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:GERALDINE
Authorized Official - Last Name:KIRBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-693-5868
Mailing Address - Street 1:204 GATEWAY N
Mailing Address - Street 2:SUITE A
Mailing Address - City:MARBLE FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:78654-6361
Mailing Address - Country:US
Mailing Address - Phone:830-693-3787
Mailing Address - Fax:830-693-4086
Practice Address - Street 1:204 GATEWAY N
Practice Address - Street 2:SUITE A
Practice Address - City:MARBLE FALLS
Practice Address - State:TX
Practice Address - Zip Code:78654-6361
Practice Address - Country:US
Practice Address - Phone:830-693-3787
Practice Address - Fax:830-693-4086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX03781TG152W00000X
TXF3196207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2051831Medicaid
TX097888402Medicaid
TX2051831Medicaid
TX097888402Medicaid
0555030001Medicare NSC