=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114007374
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KAREN OPTICAL, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 412 FOX HUNT DR
-----------------------------------------------------
City | BEAR
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19701-2538
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-834-7717
-----------------------------------------------------
Fax | 302-834-7701
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 412 FOX HUNT DR
-----------------------------------------------------
City | BEAR
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19701-2538
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-834-7717
-----------------------------------------------------
Fax | 302-834-7701
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | MRS. LINDA HAZEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 302-834-7717
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 156FX1800X
-----------------------------------------------------
Taxonomy Name | Optician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------