Provider Demographics
NPI:1275528960
Name:LUVAAS, KATHERINE DAWN (OD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:DAWN
Last Name:LUVAAS
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 1:123 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:PA
Mailing Address - Zip Code:15857-1102
Mailing Address - Country:US
Mailing Address - Phone:814-834-2165
Mailing Address - Fax:814-834-9450
Practice Address - Street 1:123 CENTER ST
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:PA
Practice Address - Zip Code:15857-1102
Practice Address - Country:US
Practice Address - Phone:814-834-2165
Practice Address - Fax:814-834-9450
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000619152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014279500001Medicaid
PALU487200OtherBLUE CROSS/BLUE SHIELD
PA06534300001OtherMEDICARE DME
PA410023276OtherRAILROAD MEDICARE
PALU487200OtherBLUE CROSS/BLUE SHIELD
PA0014279500001Medicaid