Provider Demographics
NPI:1912176256
Name:JOHN D. KIERNAN OD
Entity Type:Organization
Organization Name:JOHN D. KIERNAN OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:KIERNAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:712-252-4406
Mailing Address - Street 1:1214 PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51105-1417
Mailing Address - Country:US
Mailing Address - Phone:712-252-4406
Mailing Address - Fax:712-252-5296
Practice Address - Street 1:1214 PIERCE ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51105-1417
Practice Address - Country:US
Practice Address - Phone:712-252-4406
Practice Address - Fax:712-252-5296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1687332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0264600001OtherDME
IA17801OtherMEDICARE
IA0264600001OtherDME
IA17801OtherMEDICARE