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General NPI Number Information
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NPI Number | 1265767107
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Entity Type | Individual
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Provider Name | KAREN MAK O.D.
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Gender | Female
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Dates
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Enumeration Date | 10/09/2009
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Last Update Date | 03/26/2015
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Provider Practice Location Address
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Address Line | 100 COUNTRY CLUB LN
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City | ANDERSON
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State | SC
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Zip | 29625-1717
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Country | US
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Telephone | 864-224-5783
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Fax |
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Provider Business Mailing Address
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Address Line | 212 MARET RD
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City | TOWNVILLE
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State | SC
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Zip | 29689
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Country | US
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Telephone | 678-327-5457
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT002560
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1616
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License Number State | SC
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