Provider Demographics
NPI:1912631664
Name:KIRK, SYDNEY DAWN
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:DAWN
Last Name:KIRK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12504 US ROUTE 60
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41102-9687
Mailing Address - Country:US
Mailing Address - Phone:606-929-9440
Mailing Address - Fax:606-929-9622
Practice Address - Street 1:12504 US ROUTE 60
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41102-9687
Practice Address - Country:US
Practice Address - Phone:606-929-9440
Practice Address - Fax:606-929-9622
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-10
Last Update Date:2022-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY266470156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician