Healthcare Provider Details

I. General information

NPI: 1679458335
Provider Name (Legal Business Name): KATIE NICOLE WILLIS OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2025
Last Update Date: 08/11/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 1ST ST N
ALABASTER AL
35007-9340
US

IV. Provider business mailing address

300 1ST ST N
ALABASTER AL
35007-9340
US

V. Phone/Fax

Practice location:
  • Phone: 205-949-2020
  • Fax: 205-663-2015
Mailing address:
  • Phone: 205-949-2020
  • Fax: 205-663-2015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberS-F60-TA-D59
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: