Healthcare Provider Details

I. General information

NPI: 1376667378
Provider Name (Legal Business Name): KAREN HOBLITZELL O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2007
Last Update Date: 07/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 MAIN ST
RAINELLE WV
25962-1253
US

IV. Provider business mailing address

1102 MAIN ST
RAINELLE WV
25962-1253
US

V. Phone/Fax

Practice location:
  • Phone: 304-438-8574
  • Fax: 304-438-8753
Mailing address:
  • Phone: 304-438-8574
  • Fax: 304-438-8753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number744-D
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: