Provider Demographics
NPI:1104111988
Name:KREPLEY, KATHLEEN CORCORAN OKTAVEC (MD, MHS)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:CORCORAN OKTAVEC
Last Name:KREPLEY
Suffix:
Gender:F
Credentials:MD, MHS
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:CORCORAN
Other - Last Name:OKTAVEC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, MHS
Mailing Address - Street 1:100 WHETSTONE PLACE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 WHETSTONE PLACE
Practice Address - Street 2:SUITE 106
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086
Practice Address - Country:US
Practice Address - Phone:904-826-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME131922207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology