Healthcare Provider Details

I. General information

NPI: 1598709115
Provider Name (Legal Business Name): KAREN M GORMAN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1713 S MAIN ST
MARYVILLE MO
64468-6446
US

IV. Provider business mailing address

3602 WEST COLONY SQUARE
ST JOSEPH MO
64506-1519
US

V. Phone/Fax

Practice location:
  • Phone: 660-582-8911
  • Fax: 660-582-2545
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberMO 02665
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: