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General NPI Number Information
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NPI Number | 1184710725
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Entity Type | Individual
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Provider Name | KATHRYN WANDEL O.D.
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Gender | Female
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 03/17/2023
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Provider Practice Location Address
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Address Line | 2570 NORTHSHORE BLVD STE 200
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City | FLOWER MOUND
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State | TX
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Zip | 75028-8386
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Country | US
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Telephone | 972-539-3900
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Fax | 972-539-7333
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Provider Business Mailing Address
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Address Line | 8614 WESTWOOD CENTER DR FL 9
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City | VIENNA
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State | VA
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Zip | 22182-2442
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Country | US
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Telephone | 703-847-8899
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 18002987B
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2421
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 13459T
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 9874
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License Number State | TX
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