Provider Demographics
NPI:1558154021
Name:KIERSTEAD, KORBIN DANIEL (OD)
Entity type:Individual
Prefix:DR
First Name:KORBIN
Middle Name:DANIEL
Last Name:KIERSTEAD
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 1:221 MAIN ST N UNIT 809
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-1418
Mailing Address - Country:US
Mailing Address - Phone:920-279-1814
Mailing Address - Fax:
Practice Address - Street 1:221 MAIN ST N UNIT 809
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716-1418
Practice Address - Country:US
Practice Address - Phone:920-279-1814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-27
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6675152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist