Individual
CAROL LYNN KIRK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12910 STATE ROUTE 664 S, LOGAN, OH 43138-8564
(740) 380-1939
Mailing address
12910 STATE ROUTE 664 S, LOGAN, OH 43138-8564
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
OP.12205-SC
OH
Other
Enumeration date
02/09/2023
Last updated
02/09/2023
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