Healthcare Provider Details

I. General information

NPI: 1811059827
Provider Name (Legal Business Name): SHAHANE T. KIRMAN OD & ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 06/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 W MAIN ST
HUMMELSTOWN PA
17036-1538
US

IV. Provider business mailing address

29 W MAIN ST
HUMMELSTOWN PA
17036-1538
US

V. Phone/Fax

Practice location:
  • Phone: 717-566-3216
  • Fax: 717-256-0030
Mailing address:
  • Phone: 717-566-3216
  • Fax: 717-256-0030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberOEG000924
License Number StatePA

VIII. Authorized Official

Name: DR. GARY S KIRMAN
Title or Position: GROUP OWNER/OPTOMETRIST
Credential: OD
Phone: 717-566-3216