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Individual

DR. TIMOTHY R KIRK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
O.D.

Contact information

Practice address
22350 NOVI RD, NOVI, MI 48375-4708
(248) 347-7800
Mailing address
PO BOX 208177, DALLAS, TX 75320-8177
(636) 200-4393
(636) 527-0766

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901003020
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
383145055
TAX ID
MI
01
900F365750
BCBS PROVIDER CODE
MI
Enumeration date
01/24/2007
Last updated
05/25/2021
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