Provider Demographics
NPI:1194278382
Name:POWERS, KATELYN (OD)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:POWERS
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 1:819 S HOLLADAY DR
Mailing Address - Street 2:
Mailing Address - City:SEASIDE
Mailing Address - State:OR
Mailing Address - Zip Code:97138-6608
Mailing Address - Country:US
Mailing Address - Phone:503-325-4401
Mailing Address - Fax:503-325-4449
Practice Address - Street 1:553 18TH ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-3505
Practice Address - Country:US
Practice Address - Phone:503-325-4401
Practice Address - Fax:503-325-4449
Is Sole Proprietor?:No
Enumeration Date:2016-07-25
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4049AT152W00000X
WA60677583152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist