Provider Demographics
NPI:1801885132
Name:KATZ, NEIL (OD)
Entity type:Individual
Prefix:DR
First Name:NEIL
Middle Name:
Last Name:KATZ
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 1:471 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4219
Mailing Address - Country:US
Mailing Address - Phone:909-949-8888
Mailing Address - Fax:
Practice Address - Street 1:471 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4219
Practice Address - Country:US
Practice Address - Phone:909-949-8888
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6476T152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0064763Medicaid
CASD0064762Medicaid
CASD0064761Medicaid
CASD0064760Medicaid
CASD0064761Medicaid
SD0064760Medicare ID - Type Unspecified