Provider Demographics
NPI:1821048802
Name:MOR, KATHERINE (OD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:
Last Name:MOR
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 1:4631 S HULEN ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-1401
Mailing Address - Country:US
Mailing Address - Phone:817-346-7077
Mailing Address - Fax:817-916-5349
Practice Address - Street 1:4631 S HULEN ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-1401
Practice Address - Country:US
Practice Address - Phone:817-346-7077
Practice Address - Fax:817-916-5349
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6495TG152W00000X
CA12775 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB127618OtherMEDICARE ID
TXTXB127618OtherMEDICARE ID
TX8B8851Medicare ID - Type UnspecifiedPROVIDER #