Provider Demographics
NPI:1053186049
Name:PREUSSER, KATYE ANN
Entity type:Individual
Prefix:
First Name:KATYE
Middle Name:ANN
Last Name:PREUSSER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATYE
Other - Middle Name:ANN
Other - Last Name:PREUSSER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICENSED OPTICIAN
Mailing Address - Street 1:66 MULBERRY CIR
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-3487
Mailing Address - Country:US
Mailing Address - Phone:434-420-3577
Mailing Address - Fax:
Practice Address - Street 1:3227 OLD FOREST RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-2325
Practice Address - Country:US
Practice Address - Phone:434-200-9284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1101004518156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician