MEDICARE: NATALIE MARIE KOEDERITZ MD

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	207W00000X	Ophthalmology Physician	04-32373	KS
2	207WX0110X	Pediatric Ophthalmology and Strabismus Specialist Physician	04-32373	KS

General Provider Information

NPI Number	:	1356386494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATALIE MARIE KOEDERITZ MD

Provider Business Mailing Address
First Line	:	1421 OREAD WEST ST STE A
Second Line	:
City	:	LAWRENCE
State	:	KS
Zip	:	66049-3844
Country	:	US
Telephone Number	:	785-856-7732
Fax Number	:	785-260-6275

Provider Business Practice Location Address
First Line	:	1421 OREAD WEST ST STE A
Second Line	:
City	:	LAWRENCE
State	:	KS
Zip	:	66049-3844
Country	:	US
Telephone Number	:	785-856-7732
Fax Number	:	785-260-6275

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

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	04/23/2026

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