Provider Demographics
NPI:1801980347
Name:KIRMAN, GARY SCOTT (OD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:SCOTT
Last Name:KIRMAN
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 1:29 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:HUMMELSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17036-1538
Mailing Address - Country:US
Mailing Address - Phone:717-566-3216
Mailing Address - Fax:717-256-0030
Practice Address - Street 1:29 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:HUMMELSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17036-1538
Practice Address - Country:US
Practice Address - Phone:717-566-3216
Practice Address - Fax:717-256-0030
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000924152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT30716Medicare UPIN
PA505364M21Medicare ID - Type Unspecified
PA0425060001Medicare NSC