Provider Demographics
NPI:1376736264
Name:WOODALL, KATY LEIGH (OD)
Entity Type:Individual
Prefix:DR
First Name:KATY
Middle Name:LEIGH
Last Name:WOODALL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 HOSPITAL RD
Mailing Address - Street 2:SUITE H
Mailing Address - City:WINCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37398-2470
Mailing Address - Country:US
Mailing Address - Phone:931-967-2230
Mailing Address - Fax:931-967-9622
Practice Address - Street 1:183 HOSPITAL RD
Practice Address - Street 2:SUITE H
Practice Address - City:WINCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37398-2470
Practice Address - Country:US
Practice Address - Phone:931-967-2230
Practice Address - Fax:931-967-9622
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-23
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2752152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ007544Medicaid