Provider Demographics
NPI:1194078865
Name:BARRY KATZMAN, M.D., INC., APC
Entity type:Organization
Organization Name:BARRY KATZMAN, M.D., INC., APC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:KATZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-697-4600
Mailing Address - Street 1:6945 EL CAJON BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-1754
Mailing Address - Country:US
Mailing Address - Phone:619-697-4600
Mailing Address - Fax:619-464-5526
Practice Address - Street 1:1620 ALPINE BLVD
Practice Address - Street 2:#117
Practice Address - City:ALPINE
Practice Address - State:CA
Practice Address - Zip Code:91901-1102
Practice Address - Country:US
Practice Address - Phone:619-445-2687
Practice Address - Fax:619-445-0801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA152W00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0708860001Medicare NSC