Provider Demographics
NPI:1447811914
Name:RATLIFFE, KATIE MARIE (OD)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:MARIE
Last Name:RATLIFFE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:MARIE
Other - Last Name:CARGILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1505 FESSENDEN AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-2135
Mailing Address - Country:US
Mailing Address - Phone:231-250-1348
Mailing Address - Fax:
Practice Address - Street 1:7700 N ALGER RD
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801-9320
Practice Address - Country:US
Practice Address - Phone:989-463-6770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901005380152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist