Provider Demographics
NPI:1467652719
Name:WEEDEN, KATIE JOY (OD)
Entity Type:Individual
Prefix:DR
First Name:KATIE
Middle Name:JOY
Last Name:WEEDEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:KATIE
Other - Middle Name:JOY
Other - Last Name:HAHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:602 N MAGUIRE ST
Mailing Address - Street 2:
Mailing Address - City:WARRENSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:64093-1420
Mailing Address - Country:US
Mailing Address - Phone:660-747-7300
Mailing Address - Fax:
Practice Address - Street 1:602 N MAGUIRE ST
Practice Address - Street 2:
Practice Address - City:WARRENSBURG
Practice Address - State:MO
Practice Address - Zip Code:64093-1420
Practice Address - Country:US
Practice Address - Phone:660-747-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007019154152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
04580012OtherBLUE CROSS BLUE SHIELD 8 DIGIT BILLING NUMBER
39666014OtherBLUE CROSS BLUE SHIELD KC
G49F708BMedicare PIN
04580012OtherBLUE CROSS BLUE SHIELD 8 DIGIT BILLING NUMBER
0710770002Medicare NSC
0710770003Medicare NSC