Provider Demographics
NPI:1821205568
Name:OSBORN, KATHERINE LOUISE (OD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:LOUISE
Last Name:OSBORN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:LOUISE
Other - Last Name:JOHNSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1877A N. BLUFF ST.
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MO
Mailing Address - Zip Code:65251-2465
Mailing Address - Country:US
Mailing Address - Phone:573-592-7484
Mailing Address - Fax:573-592-0375
Practice Address - Street 1:1877A N. BLUFF ST.
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MO
Practice Address - Zip Code:65251-2465
Practice Address - Country:US
Practice Address - Phone:573-592-7484
Practice Address - Fax:573-592-0375
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006023495152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO317220408Medicaid
MO139700003Medicare PIN