Provider Demographics
NPI:1477671865
Name:JULIANO, KATHLEEN DIANE (OD)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:DIANE
Last Name:JULIANO
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 1:9 BENTON RD
Mailing Address - Street 2:
Mailing Address - City:TRAVELERS REST
Mailing Address - State:SC
Mailing Address - Zip Code:29690
Mailing Address - Country:US
Mailing Address - Phone:864-834-3111
Mailing Address - Fax:864-834-0567
Practice Address - Street 1:9 BENTON RD
Practice Address - Street 2:
Practice Address - City:TRAVELERS REST
Practice Address - State:SC
Practice Address - Zip Code:29690
Practice Address - Country:US
Practice Address - Phone:864-834-3111
Practice Address - Fax:864-834-0567
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1116152W00000X
NC1928152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist