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General NPI Number Information
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NPI Number | 1376771410
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Entity Type | Individual
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Provider Name | KIRSTEN DONNELLON O.D.
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Gender | Female
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Dates
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Enumeration Date | 06/28/2009
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Last Update Date | 07/28/2025
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Provider Practice Location Address
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Address Line | 123 E BROAD ST
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City | LINDEN
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State | MI
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Zip | 48451-9126
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Country | US
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Telephone | 810-735-9988
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Fax | 810-458-6575
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Provider Business Mailing Address
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Address Line | 89 S WASHINGTON ST
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City | OXFORD
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State | MI
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Zip | 48371-4979
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Country | US
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Telephone | 248-628-3441
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Fax | 248-628-5105
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1558
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4901004554
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License Number State | MI
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