MEDICARE: DR. KATHLEEN EVANS 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	1862	SC

General Provider Information

NPI Number	:	1598129876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHLEEN EVANS O.D.

Provider Business Mailing Address
First Line	:	8614 WESTWOOD CENTER DR FL 9
Second Line	:
City	:	VIENNA
State	:	VA
Zip	:	22182-2442
Country	:	US
Telephone Number	:	703-847-8899
Fax Number	:	571-223-6780

Provider Business Practice Location Address
First Line	:	1826 HIGHWAY 160 W STE 101
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29708-8254
Country	:	US
Telephone Number	:	803-650-3080
Fax Number	:	803-650-3081

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

Provider Enumeration Date	:	04/12/2016
Last Update Date	:	08/20/2024

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