Healthcare Provider Details

I. General information

NPI: 1275528960
Provider Name (Legal Business Name): KATHERINE DAWN LUVAAS O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 02/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 CENTER ST
SAINT MARYS PA
15857-1102
US

IV. Provider business mailing address

123 CENTER ST
SAINT MARYS PA
15857-1102
US

V. Phone/Fax

Practice location:
  • Phone: 814-834-2165
  • Fax: 814-834-9450
Mailing address:
  • Phone: 814-834-2165
  • Fax: 814-834-9450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG000619
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: