Provider Demographics
NPI:1063499176
Name:WITMEYER, KATHERINE JENNIFER (OD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:JENNIFER
Last Name:WITMEYER
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 1:2653 GATEWAY RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-1758
Mailing Address - Country:US
Mailing Address - Phone:760-476-1921
Mailing Address - Fax:760-476-2784
Practice Address - Street 1:2653 GATEWAY RD
Practice Address - Street 2:SUITE 101
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-1758
Practice Address - Country:US
Practice Address - Phone:760-476-1921
Practice Address - Fax:760-476-2784
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT12416152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABV300ZMedicare PIN