Provider Demographics
NPI:1659891901
Name:MIRICH, KATHERINE MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:MARIE
Last Name:MIRICH
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 1:1315 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVER FALLS
Mailing Address - State:PA
Mailing Address - Zip Code:15010-4213
Mailing Address - Country:US
Mailing Address - Phone:724-843-1870
Mailing Address - Fax:
Practice Address - Street 1:1315 6TH AVE
Practice Address - Street 2:
Practice Address - City:BEAVER FALLS
Practice Address - State:PA
Practice Address - Zip Code:15010-4213
Practice Address - Country:US
Practice Address - Phone:724-843-1870
Practice Address - Fax:724-843-1870
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-27
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003276152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist