Healthcare Provider Details

I. General information

NPI: 1821052176
Provider Name (Legal Business Name): KAREN ROBERSON KUDIJA OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 12/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 VINE ST
PASO ROBLES CA
93446
US

IV. Provider business mailing address

1112 VINE ST
PASO ROBLES CA
93446
US

V. Phone/Fax

Practice location:
  • Phone: 805-238-1001
  • Fax: 805-237-1057
Mailing address:
  • Phone: 805-238-1001
  • Fax: 805-237-1057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number9587T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: