Provider Demographics
NPI:1518418565
Name:ACADEMIA, CATHERINE (OD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:ACADEMIA
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 1:20120 EDWIN MARKHAM DR
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94552-5093
Mailing Address - Country:US
Mailing Address - Phone:510-537-7370
Mailing Address - Fax:
Practice Address - Street 1:5800 NORTHGATE DR
Practice Address - Street 2:SUITE 36
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-3691
Practice Address - Country:US
Practice Address - Phone:415-507-0440
Practice Address - Fax:415-492-1365
Is Sole Proprietor?:No
Enumeration Date:2016-10-14
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15460152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist