Healthcare Provider Details

I. General information

NPI: 1376545442
Provider Name (Legal Business Name): KIRK A HEARNE O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2005
Last Update Date: 08/03/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 N STATE ST
NORTH VERNON IN
47265-1724
US

IV. Provider business mailing address

865 W COUNTY ROAD 60 S
NORTH VERNON IN
47265-4832
US

V. Phone/Fax

Practice location:
  • Phone: 812-346-4646
  • Fax: 812-352-6262
Mailing address:
  • Phone: 812-346-5556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number18002748B
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: