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General NPI Number Information
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NPI Number | 1417531260
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Entity Type | Individual
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Provider Name | KATELYN MARIE MARKS OD
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Gender | Female
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Dates
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Enumeration Date | 05/07/2021
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Last Update Date | 05/27/2021
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Provider Practice Location Address
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Address Line | 6 S 14TH ST
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-3212
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Country | US
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Telephone | 904-261-5741
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Fax |
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Provider Business Mailing Address
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Address Line | 3059 SEA MARSH RD
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-5055
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Country | US
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Telephone | 920-896-3187
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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 | OPC5920
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License Number State | FL
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