Provider Demographics
NPI:1598218752
Name:RICHARDSON, KATIE ELIZABETH (OD)
Entity Type:Individual
Prefix:DR
First Name:KATIE
Middle Name:ELIZABETH
Last Name:RICHARDSON
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 1:1413 W MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-3451
Mailing Address - Country:US
Mailing Address - Phone:662-205-4654
Mailing Address - Fax:662-205-4669
Practice Address - Street 1:1413 W MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-3451
Practice Address - Country:US
Practice Address - Phone:662-205-4654
Practice Address - Fax:662-205-4669
Is Sole Proprietor?:No
Enumeration Date:2016-07-24
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS940152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist