Provider Demographics
NPI:1417947110
Name:HARANO, KATHERINE S (OD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:S
Last Name:HARANO
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 1:3935 BEACON AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1458
Mailing Address - Country:US
Mailing Address - Phone:510-792-9900
Mailing Address - Fax:510-792-9906
Practice Address - Street 1:3935 BEACON AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1458
Practice Address - Country:US
Practice Address - Phone:510-792-9900
Practice Address - Fax:510-792-9906
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5869152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0058711Medicaid
CASD0058711Medicaid
CAT10149Medicare UPIN