Healthcare Provider Details

I. General information

NPI: 1194078865
Provider Name (Legal Business Name): BARRY KATZMAN, M.D., INC., APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2012
Last Update Date: 10/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 ALPINE BLVD #117
ALPINE CA
91901-1102
US

IV. Provider business mailing address

6945 EL CAJON BLVD
SAN DIEGO CA
92115-1754
US

V. Phone/Fax

Practice location:
  • Phone: 619-445-2687
  • Fax: 619-445-0801
Mailing address:
  • Phone: 619-697-4600
  • Fax: 619-464-5526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. BARRY A KATZMAN
Title or Position: OWNER/MEDICAL DIRECTOR
Credential: M.D.
Phone: 619-697-4600