Provider Demographics
NPI:1982738134
Name:DR. SANFORD KATIMS
Entity Type:Organization
Organization Name:DR. SANFORD KATIMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANFORD
Authorized Official - Middle Name:
Authorized Official - Last Name:KATIMS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:516-767-2106
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004141152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC31191Medicare ID - Type Unspecified
NY0462110001Medicare NSC
NYT48979Medicare UPIN