Provider Demographics
NPI:1144230517
Name:WEISE, KATHERINE (OD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:
Last Name:WEISE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:NIEMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1716 UNIVERSITY BLVD
Mailing Address - Street 2:HPB G080A
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35294-0010
Mailing Address - Country:US
Mailing Address - Phone:205-975-2020
Mailing Address - Fax:205-934-6755
Practice Address - Street 1:1716 UNIVERSITY BLVD
Practice Address - Street 2:HPB G080A
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35294-0010
Practice Address - Country:US
Practice Address - Phone:205-975-2020
Practice Address - Fax:205-934-6755
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALSA33TA287152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51035147OtherBCBS OF ALABAMA
ALU57411OtherVIVA
41002840OtherMEDICARE RAILROAD
AL51035887OtherBCBS
AL000035887Medicaid
MS04500362Medicaid
AL51035147OtherBCBS OF ALABAMA
AL1387502Medicare ID - Type UnspecifiedTRAVELER
MS04500362Medicaid
AL000035147Medicare PIN