MEDICARE: DR. KATHERINE JENNIFER WITMEYER O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OPT12416	CA

General Provider Information

NPI Number	:	1063499176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHERINE JENNIFER WITMEYER O.D.

Provider Business Mailing Address
First Line	:	PO BOX 2644
Second Line	:
City	:	RANCHO SANTA FE
State	:	CA
Zip	:	92067-2644
Country	:	US
Telephone Number	:	858-381-3123
Fax Number	:	858-381-3414

Provider Business Practice Location Address
First Line	:	6037 LA GRANADA, STE F
Second Line	:	PMB 2644
City	:	RANCHO SANTA FE
State	:	CA
Zip	:	92067-2644
Country	:	US
Telephone Number	:	858-381-3123
Fax Number	:	858-381-3414

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2005
Last Update Date	:	03/25/2026

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