Provider Demographics
NPI:1902111040
Name:DUNATOV, KATHERINE SUSAN (OD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:SUSAN
Last Name:DUNATOV
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12760 INDIAN ROCKS RD
Mailing Address - Street 2:APT 410
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33774-2300
Mailing Address - Country:US
Mailing Address - Phone:617-943-0977
Mailing Address - Fax:
Practice Address - Street 1:10000 BAY PINES BOULEVARD
Practice Address - Street 2:3A-EYE CLINIC
Practice Address - City:BAY PINES
Practice Address - State:FL
Practice Address - Zip Code:33744
Practice Address - Country:US
Practice Address - Phone:727-398-6661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-13
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002401152W00000X
FLOPC 4563152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist