Healthcare Provider Details

I. General information

NPI: 1063499176
Provider Name (Legal Business Name): KATHERINE JENNIFER WITMEYER O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6037 LA GRANADA SUITE F
RANCHO SANTA FE CA
92067
US

IV. Provider business mailing address

PO BOX 2644
RANCHO SANTA FE CA
92067-2644
US

V. Phone/Fax

Practice location:
  • Phone: 858-381-3123
  • Fax: 858-381-3414
Mailing address:
  • Phone: 858-381-3123
  • Fax: 858-381-3414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT12416
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: