Provider Demographics
NPI:1043324833
Name:KATZ, KEVIN (OD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:KATZ
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:KEVIN
Other - Middle Name:
Other - Last Name:KATZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:515 22ND ST
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77550-1922
Mailing Address - Country:US
Mailing Address - Phone:409-762-8679
Mailing Address - Fax:409-762-2821
Practice Address - Street 1:515 22ND ST
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77550-1922
Practice Address - Country:US
Practice Address - Phone:409-762-8679
Practice Address - Fax:409-762-2821
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0257TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0257TGOtherMEDICAL OPTOMETRY LICENSE
TX0257TGOtherMEDICAL OPTOMETRY LICENSE
TXT14128Medicare UPIN
TX8D2103Medicare PIN