Provider Demographics
NPI:1508918566
Name:HORNER, KATHERINE MARGARET (OD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:MARGARET
Last Name:HORNER
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 1:10016 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IL
Mailing Address - Zip Code:60071-9503
Mailing Address - Country:US
Mailing Address - Phone:815-678-3937
Mailing Address - Fax:815-678-3737
Practice Address - Street 1:10016 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IL
Practice Address - Zip Code:60071-9503
Practice Address - Country:US
Practice Address - Phone:815-678-3937
Practice Address - Fax:815-678-3737
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILMH0440379OtherDEA
ILMH0440379OtherDEA
ILU75891Medicare UPIN