Provider Demographics
NPI:1396707196
Name:KIRK, SHEILA W (OD)
Entity type:Individual
Prefix:DR
First Name:SHEILA
Middle Name:W
Last Name:KIRK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 207243
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-7243
Mailing Address - Country:US
Mailing Address - Phone:636-200-4393
Mailing Address - Fax:636-527-0766
Practice Address - Street 1:4500 VALLEYDALE RD STE 700
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-4634
Practice Address - Country:US
Practice Address - Phone:205-995-0700
Practice Address - Fax:205-991-9600
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-778-TA-389152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
18180OtherAVESIS
5429OtherDAVIS VISION
06210OtherBCBS OF ALABAMA
ALS-778-TA-389OtherBOARD OF OPTOMETRY LICENS
5429OtherDAVIS VISION