Provider Demographics
NPI:1588224026
Name:PALMER, KATELYN (OD)
Entity Type:Individual
Prefix:DR
First Name:KATELYN
Middle Name:
Last Name:PALMER
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 1:16854 SUGAR BOTTOM RD
Mailing Address - Street 2:
Mailing Address - City:STE GENEVIEVE
Mailing Address - State:MO
Mailing Address - Zip Code:63670-8528
Mailing Address - Country:US
Mailing Address - Phone:573-883-0652
Mailing Address - Fax:
Practice Address - Street 1:101 W 4TH ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-3638
Practice Address - Country:US
Practice Address - Phone:540-387-1183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002784152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist