MEDICARE: DR. JOEL S KIRSCH OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	4143	NJ

General Provider Information

NPI Number	:	1386601276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOEL S KIRSCH OD

Provider Business Mailing Address
First Line	:	139 EVANS RD
Second Line	:
City	:	BLOOMFIELD
State	:	NJ
Zip	:	07003-5511
Country	:	US
Telephone Number	:	973-736-9700
Fax Number	:

Provider Business Practice Location Address
First Line	:	495 PROSPECT AVE
Second Line	:	ESSEX GREEN PLAZA
City	:	WEST ORANGE
State	:	NJ
Zip	:	07052-4100
Country	:	US
Telephone Number	:	973-736-9700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	07/08/2007

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