Provider Demographics
NPI:1871332973
Name:KUDRNA, KATELYN JEAN (OD)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:JEAN
Last Name:KUDRNA
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 1:105 GAUL DR
Mailing Address - Street 2:
Mailing Address - City:SERGEANT BLUFF
Mailing Address - State:IA
Mailing Address - Zip Code:51054-8973
Mailing Address - Country:US
Mailing Address - Phone:712-943-9400
Mailing Address - Fax:712-943-9403
Practice Address - Street 1:105 GAUL DR
Practice Address - Street 2:
Practice Address - City:SERGEANT BLUFF
Practice Address - State:IA
Practice Address - Zip Code:51054-8973
Practice Address - Country:US
Practice Address - Phone:712-943-9400
Practice Address - Fax:712-943-9403
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-20
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA126445152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist