Healthcare Provider Details

I. General information

NPI: 1689305401
Provider Name (Legal Business Name): KAREN ANN PUTILA OPTICIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2022
Last Update Date: 06/22/2022
Certification Date: 06/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4920 CENTRE POINTE DR
N CHARLESTON SC
29418-6927
US

IV. Provider business mailing address

4920 CENTRE POINTE DR
N CHARLESTON SC
29418-6927
US

V. Phone/Fax

Practice location:
  • Phone: 843-740-9191
  • Fax: 724-740-9172
Mailing address:
  • Phone: 843-740-9191
  • Fax: 724-740-9172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number141224
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: