Provider Demographics
NPI:1255489878
Name:MARCH, KAREN D (OD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:D
Last Name:MARCH
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 1:220 AUTUMN PINE DR
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:62208-2960
Mailing Address - Country:US
Mailing Address - Phone:618-334-5173
Mailing Address - Fax:618-632-2966
Practice Address - Street 1:134 SAINT CLAIR SQ
Practice Address - Street 2:#271-#272
Practice Address - City:FAIRVIEW HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:62208-2135
Practice Address - Country:US
Practice Address - Phone:618-632-2204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILV06307Medicare UPIN
ILK20295Medicare ID - Type Unspecified