Provider Demographics
NPI:1841299401
Name:CHICKOS, CATHERINE MAURO (OD)
Entity type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:MAURO
Last Name:CHICKOS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5200 HALLMARK RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27712-2058
Mailing Address - Country:US
Mailing Address - Phone:919-384-9446
Mailing Address - Fax:
Practice Address - Street 1:1510 N POINTE DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3405
Practice Address - Country:US
Practice Address - Phone:919-220-2741
Practice Address - Fax:919-220-2753
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1421152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1421OtherSTATE LICENSE NUMBER