Provider Demographics
NPI:1669434130
Name:BIDDINGER, KATHY G (OD)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:G
Last Name:BIDDINGER
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:PO BOX 668
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-0668
Mailing Address - Country:US
Mailing Address - Phone:740-593-3191
Mailing Address - Fax:740-594-2525
Practice Address - Street 1:199 COLUMBUS RD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-1315
Practice Address - Country:US
Practice Address - Phone:740-593-3191
Practice Address - Fax:740-594-2525
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4820152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2016044Medicaid
OH2016044Medicaid
OHU67456Medicare UPIN
OH2016044Medicaid