Provider Demographics
NPI:1598285397
Name:PARMALEE, KATELYN RAE (OD)
Entity Type:Individual
Prefix:DR
First Name:KATELYN
Middle Name:RAE
Last Name:PARMALEE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1005 CHARLEVOIX DR STE 100
Mailing Address - Street 2:
Mailing Address - City:GRAND LEDGE
Mailing Address - State:MI
Mailing Address - Zip Code:48837-8186
Mailing Address - Country:US
Mailing Address - Phone:517-337-1668
Mailing Address - Fax:517-622-1205
Practice Address - Street 1:1005 CHARLEVOIX DR STE 200
Practice Address - Street 2:
Practice Address - City:GRAND LEDGE
Practice Address - State:MI
Practice Address - Zip Code:48837-8186
Practice Address - Country:US
Practice Address - Phone:517-627-3030
Practice Address - Fax:517-627-8088
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-22
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901005058152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4901005058OtherSTATE LICENSE
MI1598285397Medicaid