Provider Demographics
NPI:1184710725
Name:WANDEL, KATHRYN (OD)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:
Last Name:WANDEL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:CRAWFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:
Practice Address - Street 1:2570 NORTHSHORE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-8386
Practice Address - Country:US
Practice Address - Phone:972-539-3900
Practice Address - Fax:972-539-7333
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002987B152W00000X
CO2421152W00000X
CA13459T152W00000X
TX9874152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist