Individual
MRS. KATHE S CHAMPAGNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OPTICIAN
Contact information
Practice address
12999 6TH STREET, LILLIAN, AL 36549-4107
(251) 962-3077
(251) 962-3083
Mailing address
12999 6TH ST, LILLIAN, AL 36549-4107
(251) 962-3077
(251) 962-3083
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
96872008
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0822990001
MEDICARE
AL
Enumeration date
03/17/2008
Last updated
04/17/2008
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