Provider Demographics
NPI:1568756476
Name:KATZ OPTOMETRY, P.C.
Entity Type:Organization
Organization Name:KATZ OPTOMETRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TATYANA
Authorized Official - Middle Name:I
Authorized Official - Last Name:KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:617-901-2240
Mailing Address - Street 1:210 ANDOVER ST UNIT E135
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-1638
Mailing Address - Country:US
Mailing Address - Phone:978-573-0315
Mailing Address - Fax:978-573-3224
Practice Address - Street 1:210 ANDOVER ST
Practice Address - Street 2:E135
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-1647
Practice Address - Country:US
Practice Address - Phone:978-531-3442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-08
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4576152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110089911AMedicaid
MAW1765603Medicare PIN
MA0023126Medicare PIN