Provider Demographics
NPI:1538245584
Name:DEHN, KATHRYN S (OD)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:S
Last Name:DEHN
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 1:1033 COFFEEN AVENUE
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801
Mailing Address - Country:US
Mailing Address - Phone:307-674-0444
Mailing Address - Fax:307-673-0860
Practice Address - Street 1:1033 COFFEEN AVENUE
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801
Practice Address - Country:US
Practice Address - Phone:307-674-0444
Practice Address - Fax:307-673-0860
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY291T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY120328200Medicaid
WY20082Medicare ID - Type Unspecified
U92928Medicare UPIN
WY21306Medicare PIN