Provider Demographics
NPI:1871669192
Name:O'DONNELL, CATHERINE B (OD)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:B
Last Name:O'DONNELL
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 1:52 DUANE ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10007-1207
Mailing Address - Country:US
Mailing Address - Phone:212-513-0115
Mailing Address - Fax:212-513-7730
Practice Address - Street 1:52 DUANE ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007-1207
Practice Address - Country:US
Practice Address - Phone:212-513-0115
Practice Address - Fax:212-513-7730
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005993-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYTUV005993-1OtherLICENSE