Provider Demographics
NPI:1902999154
Name:KIRKNESS, LAUREEN MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:LAUREEN
Middle Name:MARIE
Last Name:KIRKNESS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:EAST BLISS CLINIC
Mailing Address - Street 2:21227 TORCH ST., BIGGS FIELD
Mailing Address - City:FT.BLISS
Mailing Address - State:TX
Mailing Address - Zip Code:79918
Mailing Address - Country:US
Mailing Address - Phone:915-742-9975
Mailing Address - Fax:
Practice Address - Street 1:EAST BLISS CLINIC
Practice Address - Street 2:21227 TORCH ST., BIGGS FIELD
Practice Address - City:FT.BLISS
Practice Address - State:TX
Practice Address - Zip Code:79918
Practice Address - Country:US
Practice Address - Phone:915-742-9975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2943152W00000X
WA3113152W00000X
MA3674152W00000X
VA0618001811152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist