Provider Demographics
NPI:1235544909
Name:BOCK, KAITLYNN TAYLOR (OD)
Entity Type:Individual
Prefix:
First Name:KAITLYNN
Middle Name:TAYLOR
Last Name:BOCK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:64 EXECUTIVE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-8087
Mailing Address - Country:US
Mailing Address - Phone:740-233-1394
Mailing Address - Fax:740-779-3856
Practice Address - Street 1:4762 RIDGE RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:OH
Practice Address - Zip Code:44144-3327
Practice Address - Country:US
Practice Address - Phone:216-351-5300
Practice Address - Fax:216-351-5300
Is Sole Proprietor?:No
Enumeration Date:2014-06-21
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6268152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist