Provider Demographics
NPI:1851993299
Name:TAYLOR, KATHRYN LYNN (OD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:LYNN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1217 PRINCESS ANNE RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23457-1590
Mailing Address - Country:US
Mailing Address - Phone:757-343-7179
Mailing Address - Fax:
Practice Address - Street 1:701 LYNNHAVEN PKWY STE 1189
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7228
Practice Address - Country:US
Practice Address - Phone:757-463-2136
Practice Address - Fax:757-463-8917
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002955152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist