Provider Demographics
NPI:1174242879
Name:DEVERS, KIRKLAND (OD)
Entity type:Individual
Prefix:
First Name:KIRKLAND
Middle Name:
Last Name:DEVERS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 CLAREMONT AVE UNIT 6045
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07304-4380
Mailing Address - Country:US
Mailing Address - Phone:503-840-0679
Mailing Address - Fax:
Practice Address - Street 1:475 PROSPECT AVE STE 2
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-4197
Practice Address - Country:US
Practice Address - Phone:973-325-6734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00561500152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty