Healthcare Provider Details

I. General information

NPI: 1902999154
Provider Name (Legal Business Name): LAUREEN MARIE KIRKNESS O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 03/13/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EAST BLISS CLINIC 21227 TORCH ST., BIGGS FIELD
FT.BLISS TX
79918
US

IV. Provider business mailing address

EAST BLISS CLINIC 21227 TORCH ST., BIGGS FIELD
FT.BLISS TX
79918
US

V. Phone/Fax

Practice location:
  • Phone: 915-742-9975
  • Fax:
Mailing address:
  • Phone: 915-742-9975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2943
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3113
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3674
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618001811
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: