Provider Demographics
NPI:1427050475
Name:KIRK, DEBRA (OD)
Entity type:Individual
Prefix:
First Name:DEBRA
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 1:4601 W 109TH ST
Mailing Address - Street 2:STE 100
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1313
Mailing Address - Country:US
Mailing Address - Phone:913-491-0765
Mailing Address - Fax:913-317-9185
Practice Address - Street 1:4620 J C NICHOLS PKWY
Practice Address - Street 2:STE 421
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64112-1624
Practice Address - Country:US
Practice Address - Phone:816-561-0306
Practice Address - Fax:816-531-7166
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT03278152W00000X
KS1486-3152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOK711475Medicare ID - Type Unspecified
MOU75290Medicare UPIN