MEDICARE: DR. KATHERINE LOUISE OSBORN OD

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	2006023495	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821205568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHERINE LOUISE OSBORN OD

Provider Business Mailing Address
First Line	:	1877A N. BLUFF ST.
Second Line	:
City	:	FULTON
State	:	MO
Zip	:	65251-2465
Country	:	US
Telephone Number	:	573-592-7484
Fax Number	:	573-592-0375

Provider Business Practice Location Address
First Line	:	1877A N. BLUFF ST.
Second Line	:
City	:	FULTON
State	:	MO
Zip	:	65251-2465
Country	:	US
Telephone Number	:	573-592-7484
Fax Number	:	573-592-0375

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

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	02/22/2018

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