Provider Demographics
NPI:1508978735
Name:AVILA, CATALINA L (OD)
Entity Type:Individual
Prefix:MRS
First Name:CATALINA
Middle Name:L
Last Name:AVILA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:CATHY
Other - Middle Name:L
Other - Last Name:AVILA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:5488 S PADRE ISLAND DR
Mailing Address - Street 2:STE 2042
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-4122
Mailing Address - Country:US
Mailing Address - Phone:361-994-0310
Mailing Address - Fax:361-994-0452
Practice Address - Street 1:5488 S PADRE ISLAND DR
Practice Address - Street 2:STE 2042
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4147
Practice Address - Country:US
Practice Address - Phone:361-994-0310
Practice Address - Fax:361-994-0452
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5220TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U62259Medicare UPIN
TX8809B8Medicare ID - Type Unspecified
TX00E74WMedicare PIN