Provider Demographics
NPI:1508221193
Name:MCIVER, KATHY
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:MCIVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3705 STATE RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-5957
Mailing Address - Country:US
Mailing Address - Phone:440-997-2020
Mailing Address - Fax:
Practice Address - Street 1:3705 STATE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-5957
Practice Address - Country:US
Practice Address - Phone:440-997-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-23
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS. 11975156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician