Provider Demographics
NPI:1124432562
Name:KIRK, ALANNA (OD)
Entity type:Individual
Prefix:
First Name:ALANNA
Middle Name:
Last Name:KIRK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 GLOVER DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT ORAB
Mailing Address - State:OH
Mailing Address - Zip Code:45154-8390
Mailing Address - Country:US
Mailing Address - Phone:937-444-2525
Mailing Address - Fax:937-483-5230
Practice Address - Street 1:112 GLOVER DR
Practice Address - Street 2:
Practice Address - City:MOUNT ORAB
Practice Address - State:OH
Practice Address - Zip Code:45154-8390
Practice Address - Country:US
Practice Address - Phone:937-444-2525
Practice Address - Fax:937-444-4077
Is Sole Proprietor?:No
Enumeration Date:2014-06-13
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHT3208152W00000X
KY1957DT152W00000X
OHOPT.006292152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1957DTOtherCERTIFICATION
OHT3208OtherCERTIFICATION