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General NPI Number Information
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NPI Number | 1669449765
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Entity Type | Individual
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Provider Name | MICHAEL J. KATICH O.D.
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Gender | Male
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Dates
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Enumeration Date | 03/07/2006
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Last Update Date | 08/17/2022
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Provider Practice Location Address
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Address Line | 4305 BUTLER HILL RD
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City | SAINT LOUIS
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State | MO
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Zip | 63128-3718
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Country | US
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Telephone | 314-487-4744
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 207158
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City | DALLAS
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State | TX
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Zip | 75320-7158
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Country | US
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Telephone | 636-200-4393
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Fax | 636-527-0766
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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 | TO2861
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License Number State | MO
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