Provider Demographics
NPI:1528657244
Name:ADKINS, KATHLEEN SUE (OD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:SUE
Last Name:ADKINS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:SUE
Other - Last Name:ADKINS-BOLDEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1609 HARDING AVE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805-3555
Mailing Address - Country:US
Mailing Address - Phone:419-566-6948
Mailing Address - Fax:
Practice Address - Street 1:1996 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-8944
Practice Address - Country:US
Practice Address - Phone:419-281-5528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-16
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
347C00000X, 3747P1801X
OHOPT.006931152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No347C00000XTransportation ServicesPrivate Vehicle
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0430759Medicaid