Provider Demographics
NPI:1134101793
Name:KATZ, THEODORE M (OD)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:M
Last Name:KATZ
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CARNEGIE
Mailing Address - State:PA
Mailing Address - Zip Code:15106
Mailing Address - Country:US
Mailing Address - Phone:412-279-4616
Mailing Address - Fax:412-279-3700
Practice Address - Street 1:241 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CARNEGIE
Practice Address - State:PA
Practice Address - Zip Code:15106
Practice Address - Country:US
Practice Address - Phone:412-279-4616
Practice Address - Fax:412-279-3700
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE004133P152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02051736Medicaid
PA284243Medicare PIN
PA0136590001Medicare NSC
PA02051736Medicaid