Healthcare Provider Details

I. General information

NPI: 1588224026
Provider Name (Legal Business Name): KATELYN PALMER OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2019
Last Update Date: 06/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W 4TH ST
SALEM VA
24153-3638
US

IV. Provider business mailing address

16854 SUGAR BOTTOM RD
STE GENEVIEVE MO
63670-8528
US

V. Phone/Fax

Practice location:
  • Phone: 540-387-1183
  • Fax:
Mailing address:
  • Phone: 573-883-0652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618002784
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: