Provider Demographics
NPI:1124180799
Name:KIRCHNER, JEFFREY EDMUND (OD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:EDMUND
Last Name:KIRCHNER
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 1:2200 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47904-2358
Mailing Address - Country:US
Mailing Address - Phone:765-446-2814
Mailing Address - Fax:
Practice Address - Street 1:2200 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-2358
Practice Address - Country:US
Practice Address - Phone:765-446-2814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002997A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist