Provider Demographics
NPI:1881614956
Name:KATZ, DONNA KAY (OD)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:KAY
Last Name:KATZ
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 1:1940 TURNER RD SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-2003
Mailing Address - Country:US
Mailing Address - Phone:503-391-0757
Mailing Address - Fax:503-391-0758
Practice Address - Street 1:1940 TURNER RD SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-2003
Practice Address - Country:US
Practice Address - Phone:503-391-0757
Practice Address - Fax:503-391-0758
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1918ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR024716Medicaid
OR024716Medicaid