Provider Demographics
NPI:1063641421
Name:MEARS, KATRINA ANGELA (MD)
Entity Type:Individual
Prefix:DR
First Name:KATRINA
Middle Name:ANGELA
Last Name:MEARS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6901 INTERNATIONAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-7125
Mailing Address - Country:US
Mailing Address - Phone:239-939-4323
Mailing Address - Fax:239-939-3983
Practice Address - Street 1:6901 INTERNATIONAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-7125
Practice Address - Country:US
Practice Address - Phone:239-939-4323
Practice Address - Fax:239-939-3983
Is Sole Proprietor?:No
Enumeration Date:2009-07-07
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME128906207W00000X, 207WX0107X
MI4301093998207W00000X
LAMD206781207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIR417ZMedicare PIN
FLIR417YMedicare PIN