Healthcare Provider Details

I. General information

NPI: 1427007152
Provider Name (Legal Business Name): KARL BRANDON CZIRR O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 10/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4309 W 27TH PL SUITE 102
KENNEWICK WA
99338-2904
US

IV. Provider business mailing address

2459 S UNION PL STE 120
KENNEWICK WA
99338
US

V. Phone/Fax

Practice location:
  • Phone: 509-737-2010
  • Fax: 509-737-2012
Mailing address:
  • Phone: 509-737-2010
  • Fax: 509-591-0012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3567TX
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number3567TX
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number3567TX
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number3567TX
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: