Provider Demographics
NPI:1003534454
Name:SOMERVILLE, CAITLIN (OD)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:SOMERVILLE
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 1:320 WALNUT ST APT 109
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-0069
Mailing Address - Country:US
Mailing Address - Phone:610-310-7049
Mailing Address - Fax:
Practice Address - Street 1:1568 WOODBOURNE RD
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19057-1508
Practice Address - Country:US
Practice Address - Phone:215-943-7800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003951152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist