Dr. Kathy Diane Halverson, OD
Optometrist in Charlotte, NC. Individual provider (NPI-1).
NPI number1083669956
StatusActive
Last updated in NPPESMay 18, 2020
Details
- NPI
- 1083669956
- Entity type
- Individual (NPI-1)
- Name
- Dr. Kathy Diane Halverson
- Credential
- OD
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- May 22, 2006
- Certification date
- May 18, 2020
- Last updated
- May 18, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 152W00000X | Optometrist | 2457 | NM | Yes |
| 152W00000X | Optometrist | 2152 | SC | |
| 152W00000X | Optometrist | 2194 | NC |
Practice location
3506 W Tyvola RdCharlotte, NC 28208-7201
Phone 704-329-1300 · Fax 704-357-7539
Mailing address
805 Hawthorne LnCharlotte, NC 28204-2109
Phone 505-414-0592
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