Provider Demographics
NPI:1699887323
Name:KATZ, TATYANA I (OD)
Entity type:Individual
Prefix:DR
First Name:TATYANA
Middle Name:I
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 1:423 PARADISE RD
Mailing Address - Street 2:
Mailing Address - City:SWAMPSCOTT
Mailing Address - State:MA
Mailing Address - Zip Code:01907-1333
Mailing Address - Country:US
Mailing Address - Phone:339-440-5105
Mailing Address - Fax:
Practice Address - Street 1:423 PARADISE RD
Practice Address - Street 2:
Practice Address - City:SWAMPSCOTT
Practice Address - State:MA
Practice Address - Zip Code:01907-1333
Practice Address - Country:US
Practice Address - Phone:339-440-5105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4576152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0008396Medicare PIN
MAW17656Medicare PIN