Provider Demographics
NPI:1497188486
Name:BICKLE, KATHERINE (OD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:
Last Name:BICKLE
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 1:1955 NEWARK GRANVILLE RD
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43023-9170
Mailing Address - Country:US
Mailing Address - Phone:740-587-3937
Mailing Address - Fax:740-587-3589
Practice Address - Street 1:1955 NEWARK GRANVILLE RD
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:OH
Practice Address - Zip Code:43023-9170
Practice Address - Country:US
Practice Address - Phone:740-587-3937
Practice Address - Fax:740-587-3589
Is Sole Proprietor?:No
Enumeration Date:2013-08-14
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6188-T3103152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112409104Medicaid
TX1861493140OtherNPI GROUP NUMBER
TX1861493140OtherNPI GROUP NUMBER