Provider Demographics
NPI:1982992533
Name:HOLNBECK, KATIE J (OD)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:J
Last Name:HOLNBECK
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 1:2865 CHANCELLOR DR
Mailing Address - Street 2:STE 215
Mailing Address - City:CRESTVIEW HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-3931
Mailing Address - Country:US
Mailing Address - Phone:859-344-2079
Mailing Address - Fax:859-581-7207
Practice Address - Street 1:7510 US ROUTE 42
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-1908
Practice Address - Country:US
Practice Address - Phone:859-525-6215
Practice Address - Fax:859-581-7207
Is Sole Proprietor?:No
Enumeration Date:2011-07-18
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1842DT152W00000X
OH6043/T2958152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0190169Medicaid
OHH517661Medicare PIN
OH0190169Medicaid
KYK023352Medicare PIN
KYK023351Medicare PIN
OHH048356OtherPTAN / SYMMES
KYK023350OtherPTAN / KY
OHH048350OtherPTAN / GLENWAY
OHH048351OtherPTAN / COLERAIN
OHH048355OtherPTAN / TRI COUNTY