Provider Demographics
NPI:1356386197
Name:BUSBY, KATHLEEN I (OD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:I
Last Name:BUSBY
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:16409 SOUTHPARK DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-8470
Mailing Address - Country:US
Mailing Address - Phone:317-896-5005
Mailing Address - Fax:317-896-5335
Practice Address - Street 1:16409 SOUTHPARK DR
Practice Address - Street 2:SUITE B
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074-8470
Practice Address - Country:US
Practice Address - Phone:317-896-5005
Practice Address - Fax:317-896-5335
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2011-02-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ININ18002880152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN5165360001Medicare NSC
IN210020AMedicare PIN