Provider Demographics
NPI:1235210683
Name:KATZ, DARYL E (OD)
Entity Type:Individual
Prefix:DR
First Name:DARYL
Middle Name:E
Last Name:KATZ
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:14400 BEAR VALLEY RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-5470
Mailing Address - Country:US
Mailing Address - Phone:760-951-2516
Mailing Address - Fax:760-955-2227
Practice Address - Street 1:14400 BEAR VALLEY ROAD
Practice Address - Street 2:SUITE 204
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-5470
Practice Address - Country:US
Practice Address - Phone:760-951-2516
Practice Address - Fax:760-955-2227
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA9940152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA161680Medicare UPIN