MEDICARE: DEBRA KIRK O.D.

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	T03278	MO
2	152W00000X	Optometrist	1486-3	KS

General Provider Information

NPI Number	:	1427050475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA KIRK O.D.

Provider Business Mailing Address
First Line	:	4601 W 109TH ST
Second Line	:	STE 100
City	:	OVERLAND PARK
State	:	KS
Zip	:	66211-1313
Country	:	US
Telephone Number	:	913-491-0765
Fax Number	:	913-317-9185

Provider Business Practice Location Address
First Line	:	4620 J C NICHOLS PKWY
Second Line	:	STE 421
City	:	KANSAS CITY
State	:	MO
Zip	:	64112-1624
Country	:	US
Telephone Number	:	816-561-0306
Fax Number	:	816-531-7166

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

Provider Enumeration Date	:	06/02/2005
Last Update Date	:	07/08/2007

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