Healthcare Provider Details

I. General information

NPI: 1841381860
Provider Name (Legal Business Name): STEPHEN JOHN KIRWAN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 CENTER ST # 5
WOLFEBORO NH
03894-4324
US

IV. Provider business mailing address

PO BOX 1196 36 CENTER ST. #5
WOLFEBORO FALLS NH
03896-1196
US

V. Phone/Fax

Practice location:
  • Phone: 603-569-8500
  • Fax: 603-569-8905
Mailing address:
  • Phone: 603-569-8500
  • Fax: 603-569-8905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0686
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: