Provider Demographics
NPI:1073771697
Name:TEEL, KARYN E (MD)
Entity Type:Individual
Prefix:
First Name:KARYN
Middle Name:E
Last Name:TEEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 ENTERPRISE STE 200
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-2626
Mailing Address - Country:US
Mailing Address - Phone:949-688-6205
Mailing Address - Fax:
Practice Address - Street 1:751 E DAILY DR STE 110
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-6077
Practice Address - Country:US
Practice Address - Phone:805-987-8705
Practice Address - Fax:805-987-7765
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6353636-1205207W00000X
ORMD154063207W00000X
OROR154063207W00000X
CO054112207W00000X, 207W00000X
CAA116614207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500634767Medicaid
CO369348YTRTMedicare PIN
OR500634767Medicaid