Provider Demographics
NPI:1598903833
Name:SULLIVAN, KATHARINE DIRESTA (OD)
Entity Type:Individual
Prefix:DR
First Name:KATHARINE
Middle Name:DIRESTA
Last Name:SULLIVAN
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 1:680 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-2644
Mailing Address - Country:US
Mailing Address - Phone:978-374-4258
Mailing Address - Fax:
Practice Address - Street 1:680 MAIN ST
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-2644
Practice Address - Country:US
Practice Address - Phone:978-374-4258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-23
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4433152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist