Provider Demographics
NPI:1710500251
Name:ADAMS, KATIE JOANN (OD)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:JOANN
Last Name:ADAMS
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 1:1783 COUNTY ROAD W14
Mailing Address - Street 2:
Mailing Address - City:CALMAR
Mailing Address - State:IA
Mailing Address - Zip Code:52132-7517
Mailing Address - Country:US
Mailing Address - Phone:641-220-4238
Mailing Address - Fax:
Practice Address - Street 1:104 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:WEST UNION
Practice Address - State:IA
Practice Address - Zip Code:52175-1347
Practice Address - Country:US
Practice Address - Phone:563-422-6085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-19
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA101169152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist