Provider Demographics
NPI:1508833831
Name:KOMYATTE, CATERINA A (OD)
Entity Type:Individual
Prefix:
First Name:CATERINA
Middle Name:A
Last Name:KOMYATTE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:CAY
Other - Middle Name:
Other - Last Name:AGOSTINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2101 BURLINGTON BEACH RD
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-1665
Mailing Address - Country:US
Mailing Address - Phone:219-462-0309
Mailing Address - Fax:219-465-7332
Practice Address - Street 1:2101 BURLINGTON BEACH RD
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-1665
Practice Address - Country:US
Practice Address - Phone:219-462-0309
Practice Address - Fax:219-465-7332
Is Sole Proprietor?:No
Enumeration Date:2006-03-06
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002808A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
875850Medicare ID - Type Unspecified
U64471Medicare UPIN