Provider Demographics
NPI:1801314794
Name:MIAO, KATIE HOANG (OD)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:HOANG
Last Name:MIAO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:HOANG-MIAO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:474 N LAKE SHORE DR APT 4005
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-6483
Mailing Address - Country:US
Mailing Address - Phone:312-833-1605
Mailing Address - Fax:
Practice Address - Street 1:2700 N NARRAGANSETT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60639-1083
Practice Address - Country:US
Practice Address - Phone:773-622-2405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-31
Last Update Date:2025-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.011148152W00000X
LA1986932AT152W00000X
UT12715650-9934152W00000X
GAOPT003405152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist