Provider Demographics
NPI:1265021703
Name:MAM, KATHERINE (OD)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:
Last Name:MAM
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 1:91 MILL ST STE 6
Mailing Address - Street 2:
Mailing Address - City:DRACUT
Mailing Address - State:MA
Mailing Address - Zip Code:01826-3277
Mailing Address - Country:US
Mailing Address - Phone:978-957-4750
Mailing Address - Fax:
Practice Address - Street 1:91 MILL ST STE 6
Practice Address - Street 2:
Practice Address - City:DRACUT
Practice Address - State:MA
Practice Address - Zip Code:01826-3277
Practice Address - Country:US
Practice Address - Phone:978-957-4750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-11
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5445152W00000X
MA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program