Healthcare Provider Details

I. General information

NPI: 1932039872
Provider Name (Legal Business Name): KATELYN BUSH O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 LINCOLN ST
GRAFTON WV
26354-1442
US

IV. Provider business mailing address

25 W BLUEMONT ST
GRAFTON WV
26354-1242
US

V. Phone/Fax

Practice location:
  • Phone: 304-265-1851
  • Fax: 304-265-0028
Mailing address:
  • Phone: 304-265-0312
  • Fax: 304-265-0314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3107
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: