Provider Demographics
NPI:1164476248
Name:TISON, KAREN H (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:H
Last Name:TISON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:44241 15TH ST W
Mailing Address - Street 2:STE. 201
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-4037
Mailing Address - Country:US
Mailing Address - Phone:661-949-5955
Mailing Address - Fax:661-949-5958
Practice Address - Street 1:44241 15TH ST W
Practice Address - Street 2:STE. 201
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-4037
Practice Address - Country:US
Practice Address - Phone:661-949-5955
Practice Address - Fax:661-949-5958
Is Sole Proprietor?:No
Enumeration Date:2006-05-21
Last Update Date:2010-08-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG44211207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G442110Medicaid
A49584Medicare UPIN
CA00G442110Medicaid