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General NPI Number Information
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NPI Number | 1902111040
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Entity Type | Individual
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Provider Name | KATHERINE SUSAN DUNATOV O.D.
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Gender | Female
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Dates
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Enumeration Date | 08/13/2010
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Last Update Date | 06/03/2011
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Provider Practice Location Address
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Address Line | 10000 BAY PINES BOULEVARD 3A-EYE CLINIC
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City | BAY PINES
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State | FL
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Zip | 33744
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Country | US
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Telephone | 727-398-6661
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Fax |
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Provider Business Mailing Address
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Address Line | 12760 INDIAN ROCKS RD APT 410
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City | LARGO
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State | FL
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Zip | 33774-2300
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Country | US
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Telephone | 617-943-0977
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OEG002401
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC 4563
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License Number State | FL
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