Provider Demographics
NPI:1790839280
Name:KATSAITIS, IRENE (OD)
Entity Type:Individual
Prefix:DR
First Name:IRENE
Middle Name:
Last Name:KATSAITIS
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 1:1022 DUNROBIN DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-5699
Mailing Address - Country:US
Mailing Address - Phone:615-794-3388
Mailing Address - Fax:615-771-7973
Practice Address - Street 1:3600 MALLORY LN
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-2803
Practice Address - Country:US
Practice Address - Phone:615-771-5025
Practice Address - Fax:615-771-7973
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1573152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist