Provider Demographics
NPI:1801902994
Name:MARCOE, KATHY J (OD)
Entity type:Individual
Prefix:DR
First Name:KATHY
Middle Name:J
Last Name:MARCOE
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 94
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16127-0094
Mailing Address - Country:US
Mailing Address - Phone:814-676-6081
Mailing Address - Fax:814-676-6006
Practice Address - Street 1:10 KIMBERLY LN
Practice Address - Street 2:
Practice Address - City:CRANBERRY
Practice Address - State:PA
Practice Address - Zip Code:16319-3134
Practice Address - Country:US
Practice Address - Phone:814-676-6081
Practice Address - Fax:814-676-6006
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2023-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000069152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01922253Medicaid
PAU91955Medicare UPIN
PA062891Medicare PIN