Provider Demographics
NPI:1578738704
Name:HAFNER, KATHLEEN A (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A
Last Name:HAFNER
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31090 LAZY RIDGE
Mailing Address - Street 2:KATS EYE SHOP
Mailing Address - City:WALLER
Mailing Address - State:TX
Mailing Address - Zip Code:77484
Mailing Address - Country:US
Mailing Address - Phone:936-931-9033
Mailing Address - Fax:936-931-9033
Practice Address - Street 1:31090 LAZY RIDGE
Practice Address - Street 2:KATS EYE SHOP
Practice Address - City:WALLER
Practice Address - State:TX
Practice Address - Zip Code:77484
Practice Address - Country:US
Practice Address - Phone:936-931-9033
Practice Address - Fax:936-931-9033
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXREGISTRATIONDR0359156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician