Provider Demographics
NPI:1972503076
Name:TAYLOR, KATHERINE W (OD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:W
Last Name:TAYLOR
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 1:1801 ROCKLAND RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-3648
Mailing Address - Country:US
Mailing Address - Phone:302-651-4413
Mailing Address - Fax:302-651-4457
Practice Address - Street 1:1801 ROCKLAND RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-3648
Practice Address - Country:US
Practice Address - Phone:302-651-4407
Practice Address - Fax:302-651-4457
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE005871T152W00000X
DEC130001159152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0555350001OtherMEDICARE DME
PA07038510Medicaid
DE0000536722Medicaid
0555350001OtherMEDICARE DME
DE137710Medicare PIN
PA658831Medicare PIN