Individual
KATHLEEN A WOOTEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
PHOENIX INDIAN MEDICAL CENTER, 4212 N. 16TH STREET, PHOENIX, AZ 85016-5319
(602) 263-1200
Mailing address
PO BOX 31001-0698, PASADENA, CA 91110-0698
(602) 263-1200
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1609
KS
Other
Enumeration date
09/22/2006
Last updated
04/19/2019
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