Katrae Mj LLC

NPI #1003357153 in Casper, Wyoming

Provider Information

NPI Number: 1003357153
Entity Type: Organization
Organization Name: Katrae Mj LLC
Primary Specialty: Optometrist
Enumeration Date: Mar 9, 2017
Last Updated: Mar 9, 2017

Practice Location

Address: 1526 CENTENNIAL CT
City: Casper
State: Wyoming
ZIP Code: 82609-7304
Phone: (307) 237-6025

Authorized Official

Name: DR. LEVI M PORTER, O.D.
Title: OPTOMETRIST
Phone: (503) 504-6941

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Optometrist	152W00000X	Primary

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