Provider Demographics
NPI:1144223637
Name:OGLESBY, KAREN EBLING (OD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:EBLING
Last Name:OGLESBY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:KAREN
Other - Middle Name:M
Other - Last Name:EBLING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:5001 BISSONNET ST STE 107
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-4015
Mailing Address - Country:US
Mailing Address - Phone:713-664-8087
Mailing Address - Fax:713-664-8078
Practice Address - Street 1:5001 BISSONNET ST STE 107
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-4015
Practice Address - Country:US
Practice Address - Phone:713-664-8087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5801TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1667776-01Medicaid
TXU84439OtherLEGACY MEDICARE UPIN 2001 - 2012
TX8C0860OtherLEGACY MEDICARE PTAN 2001-2012
TX8C0860OtherLEGACY MEDICARE PTAN 2001-2012
TX1667776-01Medicaid
TXPO1231976Medicare PIN
TX6982360001Medicare NSC