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General NPI Number Information
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NPI Number | 1962947838
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Entity Type | Organization
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Legal Business Name | LISA KIRKLAND OD PC
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Dates
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Enumeration Date | 12/30/2016
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Last Update Date | 12/26/2022
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Provider Practice Location Address
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Address Line | 12221A GUY R BREWER BLVD
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City | JAMAICA
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State | NY
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Zip | 11434-2406
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Country | US
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Telephone | 718-527-0550
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Fax | 718-527-0546
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Provider Business Mailing Address
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Address Line | 830 ELICE PL
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City | BALDWIN
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State | NY
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Zip | 11510-3903
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Country | US
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Telephone | 917-209-3713
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. LISA KIRKLAND
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Credential | OD
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Telephone | 718-527-0550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | VUT005701
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License Number State | NY
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