Provider Demographics
NPI:1366548398
Name:CATRON, JESSE MICHAEL LAEL (OD)
Entity type:Individual
Prefix:DR
First Name:JESSE
Middle Name:MICHAEL LAEL
Last Name:CATRON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 N PARK DR
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-5017
Mailing Address - Country:US
Mailing Address - Phone:443-523-7286
Mailing Address - Fax:
Practice Address - Street 1:409 N FRUITLAND BLVD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-7201
Practice Address - Country:US
Practice Address - Phone:410-341-3481
Practice Address - Fax:410-341-4350
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1876152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist