Provider Demographics
NPI:1396833430
Name:KATIMS, SANFORD (OD)
Entity type:Individual
Prefix:DR
First Name:SANFORD
Middle Name:
Last Name:KATIMS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-2821
Mailing Address - Country:US
Mailing Address - Phone:516-767-2106
Mailing Address - Fax:516-944-3711
Practice Address - Street 1:76 MAIN ST
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-2821
Practice Address - Country:US
Practice Address - Phone:516-767-2106
Practice Address - Fax:516-944-3711
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004141152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT48979OtherMEDICARE UPIN
NYC31191Medicare ID - Type Unspecified
NYT48979Medicare UPIN