Healthcare Provider Details

I. General information

NPI: 1639361611
Provider Name (Legal Business Name): DAVID G KIRSCHEN OD PHD A PROFESSIONAL OPTOMETRIC CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2007
Last Update Date: 12/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 S BREA BLVD
BREA CA
92821-5301
US

IV. Provider business mailing address

428 S BREA BLVD
BREA CA
92821-5301
US

V. Phone/Fax

Practice location:
  • Phone: 714-529-2470
  • Fax: 866-801-4739
Mailing address:
  • Phone: 714-529-2470
  • Fax: 866-801-4739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOP5418T
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOP5418T
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License NumberOP13003T
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License NumberOP5418T
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License NumberOP5418T
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License NumberOP5418T
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License NumberOP13003T
License Number StateCA

VIII. Authorized Official

Name: DR. DAVID GARY KIRSCHEN
Title or Position: PRESIDENT
Credential: OD, PHD
Phone: 714-529-2470