Basic Information
Provider Information | |||||||||
NPI: | 1902111040 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | DUNATOV | ||||||||
FirstName: | KATHERINE | ||||||||
MiddleName: | SUSAN | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | O.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 12760 INDIAN ROCKS RD | ||||||||
Address2: | APT 410 | ||||||||
City: | LARGO | ||||||||
State: | FL | ||||||||
PostalCode: | 337742300 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6179430977 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 10000 BAY PINES BOULEVARD | ||||||||
Address2: | 3A-EYE CLINIC | ||||||||
City: | BAY PINES | ||||||||
State: | FL | ||||||||
PostalCode: | 33744 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7273986661 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/13/2010 | ||||||||
LastUpdateDate: | 06/03/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OEG002401 | PA | Y |   | Eye and Vision Services Providers | Optometrist |   | 152W00000X | OPC 4563 | FL | N |   | Eye and Vision Services Providers | Optometrist |   |
No ID Information.