Provider Demographics
NPI:1518113190
Name:KATIE G MCCREARY, OD, PL
Entity Type:Organization
Organization Name:KATIE G MCCREARY, OD, PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:GILBERT
Authorized Official - Last Name:SPEAR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:850-207-2080
Mailing Address - Street 1:601 E GOVERNMENT ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32502-6135
Mailing Address - Country:US
Mailing Address - Phone:850-207-2080
Mailing Address - Fax:850-497-0733
Practice Address - Street 1:501 N NAVY BLVD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32507-2011
Practice Address - Country:US
Practice Address - Phone:850-453-6635
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3920152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty