Provider Demographics
NPI:1508948696
Name:SCHREICK, KATHY SVANE (OD)
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:SVANE
Last Name:SCHREICK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:KATHY
Other - Middle Name:SVANE
Other - Last Name:SCHREICK-LATTO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:19180 SOLEDAD CANYON RD
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91351-3364
Mailing Address - Country:US
Mailing Address - Phone:661-298-1733
Mailing Address - Fax:
Practice Address - Street 1:19180 SOLEDAD CANYON RD
Practice Address - Street 2:
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91351-3364
Practice Address - Country:US
Practice Address - Phone:661-298-1733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10205T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist