Provider Demographics
NPI:1912301342
Name:EGAN, KATHERINE (OD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:EGAN
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 1:3804 RIVERSDALE RD
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-7611
Mailing Address - Country:US
Mailing Address - Phone:214-507-4547
Mailing Address - Fax:866-573-5747
Practice Address - Street 1:355 STONEBROOK PKWY
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034
Practice Address - Country:US
Practice Address - Phone:214-432-4370
Practice Address - Fax:866-573-5747
Is Sole Proprietor?:No
Enumeration Date:2014-10-14
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8419TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist