Provider Demographics
NPI:1780838433
Name:MADSEN, CATHERINE (OD)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:
Last Name:MADSEN
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 1:4208 SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20782-2137
Mailing Address - Country:US
Mailing Address - Phone:301-919-2694
Mailing Address - Fax:
Practice Address - Street 1:10925 BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-2117
Practice Address - Country:US
Practice Address - Phone:301-595-5959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-07
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA 1607152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist