Provider Demographics
NPI:1083096218
Name:VANHORN, KATHLEEN (OD)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:VANHORN
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 1:1015 CHESTNUT ST.
Mailing Address - Street 2:SUITE 417
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4304
Mailing Address - Country:US
Mailing Address - Phone:215-627-4448
Mailing Address - Fax:215-622-5798
Practice Address - Street 1:1015 CHESTNUT ST.
Practice Address - Street 2:SUITE 417
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19107-4304
Practice Address - Country:US
Practice Address - Phone:215-627-4448
Practice Address - Fax:215-622-5798
Is Sole Proprietor?:No
Enumeration Date:2015-06-24
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002424152W00000X
MDTA2479152W00000X
PAOEG003066152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist