MEDICARE: DR. LAUREEN MARIE KIRKNESS 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	2943	CO
2	152W00000X	Optometrist	3113	WA
3	152W00000X	Optometrist	3674	MA
4	152W00000X	Optometrist	0618001811	VA

General Provider Information

NPI Number	:	1902999154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAUREEN MARIE KIRKNESS O.D.

Provider Business Mailing Address
First Line	:	EAST BLISS CLINIC
Second Line	:	21227 TORCH ST., BIGGS FIELD
City	:	FT.BLISS
State	:	TX
Zip	:	79918
Country	:	US
Telephone Number	:	915-742-9975
Fax Number	:

Provider Business Practice Location Address
First Line	:	EAST BLISS CLINIC
Second Line	:	21227 TORCH ST., BIGGS FIELD
City	:	FT.BLISS
State	:	TX
Zip	:	79918
Country	:	US
Telephone Number	:	915-742-9975
Fax Number	:

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	03/13/2024

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