Organization
TIMOTHY R KIRK OD PC
Active
Other names
Town & Country Eyecare
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY R KIRK O.D. (PRESIDENT/OWNER)
(248) 347-7800
Entity
Organization
Contact information
Practice address
22350 NOVI RD, NOVI, MI 48375-4708
(248) 347-7800
(248) 347-7801
Mailing address
23850 HICKORY GROVE LN, NOVI, MI 48375-3162
(248) 347-7800
(248) 347-7801
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901003020
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4901003020
OD LICENSE
MI
01
—
4901003852
OD LICENSE
MI
01
—
900F310020
BCBS ID
MI
01
—
900F365750
BCBS ID
MI
01
—
ON61480
MEDICARE SUPPLIES DMERC
—
Enumeration date
09/25/2007
Last updated
12/09/2008
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