Healthcare Provider Details

I. General information

NPI: 1245958347
Provider Name (Legal Business Name): KAREN TO OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2022
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

971 MCLAUGHLIN AVE
SAN JOSE CA
95122-2612
US

IV. Provider business mailing address

1705 S 324TH PL
FEDERAL WAY WA
98003-8504
US

V. Phone/Fax

Practice location:
  • Phone: 408-286-2008
  • Fax: 408-286-2009
Mailing address:
  • Phone: 253-661-6005
  • Fax: 253-661-0633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD61312562
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD35428-TLG
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: