Provider Demographics
NPI:1205082138
Name:LATCH, KATHRYN NAOMI (OD)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:NAOMI
Last Name:LATCH
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 1:3420 BIENVILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-5732
Mailing Address - Country:US
Mailing Address - Phone:228-875-3937
Mailing Address - Fax:228-875-3930
Practice Address - Street 1:3420 BIENVILLE BLVD
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-5732
Practice Address - Country:US
Practice Address - Phone:228-875-3937
Practice Address - Fax:228-875-3930
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS798152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02505046Medicaid