Provider Demographics
NPI:1578507703
Name:NOONAN, KATHRYN (OD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:NOONAN
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 1:4921 PARKVIEW PL
Mailing Address - Street 2:STE 14F
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1032
Mailing Address - Country:US
Mailing Address - Phone:314-361-5003
Mailing Address - Fax:314-361-2686
Practice Address - Street 1:4921 PARKVIEW PL
Practice Address - Street 2:STE 14F
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-361-5003
Practice Address - Fax:314-361-2686
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02676152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU13028Medicare UPIN