Provider Demographics
NPI:1033397328
Name:DR. KAREN E. BORO
Entity Type:Organization
Organization Name:DR. KAREN E. BORO
Other - Org Name:NATIONAL OPTOMECTRIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:540-776-2930
Mailing Address - Street 1:4135 FRANKLIN ROAD, SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018
Mailing Address - Country:US
Mailing Address - Phone:540-776-2930
Mailing Address - Fax:540-776-2932
Practice Address - Street 1:4135 FRANKLIN ROAD, SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018
Practice Address - Country:US
Practice Address - Phone:540-776-2930
Practice Address - Fax:540-776-2932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000577152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009234560Medicaid
VA009235787Medicaid
VAC05777Medicare PIN
VAU71190Medicare UPIN
VAC05881Medicare PIN
VADG6067Medicare PIN
VA009235787Medicaid