Provider Demographics
NPI:1669449765
Name:KATICH, MICHAEL J (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:KATICH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 207158
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-7158
Mailing Address - Country:US
Mailing Address - Phone:636-200-4393
Mailing Address - Fax:636-527-0766
Practice Address - Street 1:4305 BUTLER HILL RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-3718
Practice Address - Country:US
Practice Address - Phone:314-487-4744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOTO2861152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12062OtherOPTICAREMEDICARE COMPLETE
179835OtherHEALTHLINK
IL410048086OtherRR MEDICARE
100684OtherBLUE CROSS BLUE SHIELD MO
110969OtherEYEMED
22-01200OtherUNITED HEALTHCARE
MO4185OtherHEALTHCARE USA
MO000091336OtherMEDICARE PART B PTAN
MO313428427Medicaid
MOP00403019OtherRR MEDICARE
MO000091347Medicare PIN
100684OtherBLUE CROSS BLUE SHIELD MO
110969OtherEYEMED