Provider Demographics
NPI:1114999588
Name:KALLMANN, KAREN (OD)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:
Last Name:KALLMANN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5710 CAHALAN
Mailing Address - Street 2:5B
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123
Mailing Address - Country:US
Mailing Address - Phone:408-225-5935
Mailing Address - Fax:408-225-3755
Practice Address - Street 1:5710 CAHALAN AVE
Practice Address - Street 2:5B
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-3010
Practice Address - Country:US
Practice Address - Phone:408-225-5935
Practice Address - Fax:408-225-3755
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5544T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4475126Medicare UPIN
CASD0055440Medicare UPIN