Healthcare Provider Details

I. General information

NPI: 1821048141
Provider Name (Legal Business Name): DAVID G. KIRSCHEN OD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 12/19/2022
Certification Date: 12/19/2022
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:
Mailing address:
  • Phone: 714-529-2470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License NumberOP5418T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: