Basic Information
| Provider Information | |||||||||
| NPI: | 1770639825 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AQUINO | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 S ELISEO DR | ||||||||
| Address2: | STE 102 | ||||||||
| City: | GREENBRAE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949042152 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154618200 | ||||||||
| FaxNumber: | 4154614627 | ||||||||
| Practice Location | |||||||||
| Address1: | 1750 EL CAMINO REAL | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | BURLINGAME | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940103228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6506922020 | ||||||||
| FaxNumber: | 6506921441 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2007 | ||||||||
| LastUpdateDate: | 07/09/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 11459T | CA | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.