Provider Demographics
NPI:1316239981
Name:AMY CATALANO OD LLC
Entity type:Organization
Organization Name:AMY CATALANO OD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:J
Authorized Official - Last Name:CATALANO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:781-821-1224
Mailing Address - Street 1:95 WASHINGTON ST STE 466
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-4008
Mailing Address - Country:US
Mailing Address - Phone:781-821-1224
Mailing Address - Fax:877-992-0275
Practice Address - Street 1:95 WASHINGTON ST STE 466
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-4008
Practice Address - Country:US
Practice Address - Phone:781-821-1224
Practice Address - Fax:877-992-0275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-13
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4402152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0710687Medicaid
MA0710687Medicaid