Provider Demographics
NPI:1598868697
Name:RICE, KATHLEEN J (OD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:J
Last Name:RICE
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 1:110 S WILLOW ST STE 108
Mailing Address - Street 2:
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-7798
Mailing Address - Country:US
Mailing Address - Phone:907-283-7575
Mailing Address - Fax:907-283-6156
Practice Address - Street 1:110 S WILLOW ST STE 108
Practice Address - Street 2:
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-7798
Practice Address - Country:US
Practice Address - Phone:907-283-7575
Practice Address - Fax:907-283-6156
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5568152W00000X
AK253152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKOD2859Medicaid
AKV11167Medicare PIN