Provider Demographics
NPI:1598591919
Name:DO, KATHERINE (OD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:DO
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 1:851 DOMINGO DR APT 23
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-4578
Mailing Address - Country:US
Mailing Address - Phone:714-385-7130
Mailing Address - Fax:
Practice Address - Street 1:363 S MAIN ST STE 325
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3818
Practice Address - Country:US
Practice Address - Phone:888-501-4496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35694-TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist