Provider Demographics
NPI:1508981069
Name:KATZ, RICHARD SAUL (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:SAUL
Last Name:KATZ
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:866-795-4020
Practice Address - Street 1:5765 BURKE CENTRE PKWY STE L
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-2264
Practice Address - Country:US
Practice Address - Phone:703-250-9000
Practice Address - Fax:703-250-7500
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000071152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
189915O02Medicare PIN
T31046Medicare UPIN