Provider Demographics
NPI:1427677095
Name:KIRK EYE LLC
Entity type:Organization
Organization Name:KIRK EYE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-287-0563
Mailing Address - Street 1:PO BOX 338
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84701-0338
Mailing Address - Country:US
Mailing Address - Phone:435-287-0563
Mailing Address - Fax:435-287-0564
Practice Address - Street 1:41 S 100 E STE J
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84701-2691
Practice Address - Country:US
Practice Address - Phone:435-287-0563
Practice Address - Fax:435-208-0564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-13
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery