Provider Demographics
NPI:1962571521
Name:COLLINS, KATHRYN E (OD)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:E
Last Name:COLLINS
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 1:1170 ERBS QUARRY RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-9767
Mailing Address - Country:US
Mailing Address - Phone:717-625-4989
Mailing Address - Fax:717-625-7360
Practice Address - Street 1:1170 ERBS QUARRY RD
Practice Address - Street 2:SUITE 4
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-9767
Practice Address - Country:US
Practice Address - Phone:717-625-4989
Practice Address - Fax:717-625-7360
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001123152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACO342834OtherBLUE CROSSBLUE SHIELD
PA397278OtherNVA
PA196609Medicare PIN
PA397278OtherNVA