Provider Demographics
NPI:1912252800
Name:MALERBI, KIRK DOMINICK JR (OD)
Entity Type:Individual
Prefix:DR
First Name:KIRK
Middle Name:DOMINICK
Last Name:MALERBI
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:2141 VINEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-5938
Mailing Address - Country:US
Mailing Address - Phone:706-270-1420
Mailing Address - Fax:
Practice Address - Street 1:1207 W WALNUT AVE
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-3958
Practice Address - Country:US
Practice Address - Phone:706-226-2722
Practice Address - Fax:706-275-6114
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-17
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002705152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I416046Medicare PIN
TN103I416072Medicare PIN