Healthcare Provider Details

I. General information

NPI: 1588759112
Provider Name (Legal Business Name): KAREN D HEALY O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 12/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 US ROUTE 1 BYP SUITE A
KITTERY ME
03904-1570
US

IV. Provider business mailing address

99 US ROUTE 1 BYP SUITE A
KITTERY ME
03904-1570
US

V. Phone/Fax

Practice location:
  • Phone: 207-439-0410
  • Fax: 207-439-8353
Mailing address:
  • Phone: 207-439-0410
  • Fax: 207-439-8353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT768
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: