Healthcare Provider Details

I. General information

NPI: 1124231105
Provider Name (Legal Business Name): KAREN U WINT O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 01/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 CARO LN
CHAPIN SC
29036-9588
US

IV. Provider business mailing address

227 CARO LN
CHAPIN SC
29036-9588
US

V. Phone/Fax

Practice location:
  • Phone: 803-932-7651
  • Fax:
Mailing address:
  • Phone: 803-932-7651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number1728
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1094
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: