MEDICARE: KATLYN CALLAHAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	3607	OH

General Provider Information

NPI Number	:	1174926778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATLYN CALLAHAN

Provider Business Mailing Address
First Line	:	2731 OBSERVATORY AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45208-2107
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2731 OBSERVATORY AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45208-2107
Country	:	US
Telephone Number	:	513-871-5200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2014
Last Update Date	:	09/27/2014

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Directions to “ KATLYN CALLAHAN ” Practice Location

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