Provider Demographics
NPI:1578572855
Name:CLORE, KATHERINE A (OD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:A
Last Name:CLORE
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 1:1716 UNIVERSITY BLVD
Mailing Address - Street 2:HPB G080A
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35294-0010
Mailing Address - Country:US
Mailing Address - Phone:205-975-2020
Mailing Address - Fax:205-934-6755
Practice Address - Street 1:1716 UNIVERSITY BLVD
Practice Address - Street 2:HPB G080A
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35294-0010
Practice Address - Country:US
Practice Address - Phone:205-975-2020
Practice Address - Fax:205-934-6755
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS503TA187152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1586013Medicaid
ALT69161OtherVIVA
AL51059867OtherBSBC OF ALABAMA
ALA1716 639005396OtherVISION SERVICE PLAN
MS01527261Medicaid
AL51059815OtherBCBS
AL000059867Medicaid
ALA1716 639005396OtherVISION SERVICE PLAN
AL1387502Medicare ID - Type UnspecifiedUMWA
MS01527261Medicaid
0279620004Medicare NSC
AL410021308Medicare ID - Type UnspecifiedTRAVELERS
AL51059867OtherBSBC OF ALABAMA
AL000059867Medicaid