Provider Demographics
NPI:1760059018
Name:BUNN, KATELYN (OD)
Entity Type:Individual
Prefix:DR
First Name:KATELYN
Middle Name:
Last Name:BUNN
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 1:310 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-4224
Mailing Address - Country:US
Mailing Address - Phone:256-547-8634
Mailing Address - Fax:
Practice Address - Street 1:100 LEGACY PARK WAY
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:AL
Practice Address - Zip Code:35146-1211
Practice Address - Country:US
Practice Address - Phone:205-467-0308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-E75152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist