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General NPI Number Information
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NPI Number | 1609043520
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Entity Type | Organization
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Legal Business Name | WILLIAM KIERNAN,O.D., INC.
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Dates
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Enumeration Date | 05/09/2008
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Last Update Date | 05/09/2008
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Provider Practice Location Address
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Address Line | 46660 WASHINGTON ST SUITE 3
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City | LA QUINTA
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State | CA
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Zip | 92253-2451
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Country | US
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Telephone | 760-564-2113
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Fax |
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Provider Business Mailing Address
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Address Line | 46660 WASHINGTON ST SUITE 3
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City | LA QUINTA
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State | CA
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Zip | 92253-2451
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Country | US
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Telephone | 760-564-2113
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Fax |
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Authorized Official
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Title or Position | PRES
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Name | DR. WILLIAM HUGH KIERNAN
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Credential | O.D.
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Telephone | 760-564-2113
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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 | 7661T
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License Number State | CA
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