Provider Demographics
NPI:1245741537
Name:MAKAYED, KATHERINE (OD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:MAKAYED
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 1:5261 MILL CREEK LN
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95136-3612
Mailing Address - Country:US
Mailing Address - Phone:929-437-3937
Mailing Address - Fax:
Practice Address - Street 1:17190 MONTEREY RD STE 100
Practice Address - Street 2:
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-3604
Practice Address - Country:US
Practice Address - Phone:408-779-5584
Practice Address - Fax:408-779-6819
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-13
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT33743-TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty