Provider Demographics
NPI:1760498125
Name:KATS, PAUL L (OD,)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:L
Last Name:KATS
Suffix:
Gender:M
Credentials:OD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2189 75TH ST
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:IL
Mailing Address - Zip Code:60561-4383
Mailing Address - Country:US
Mailing Address - Phone:630-434-7718
Mailing Address - Fax:630-434-7752
Practice Address - Street 1:2189 75TH ST
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:IL
Practice Address - Zip Code:60561-4383
Practice Address - Country:US
Practice Address - Phone:630-434-7718
Practice Address - Fax:630-434-7752
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-008429152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU49104Medicare UPIN
IL205484Medicare ID - Type Unspecified