Provider Demographics
NPI:1053935023
Name:STUCKEY, KATIE E (OD)
Entity type:Individual
Prefix:DR
First Name:KATIE
Middle Name:E
Last Name:STUCKEY
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:PO BOX 1520
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-1520
Mailing Address - Country:US
Mailing Address - Phone:662-234-3937
Mailing Address - Fax:662-234-3898
Practice Address - Street 1:1628 HIGHWAY 30 E
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-2319
Practice Address - Country:US
Practice Address - Phone:662-234-3937
Practice Address - Fax:662-234-3898
Is Sole Proprietor?:No
Enumeration Date:2020-06-04
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1013152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist