Provider Demographics
NPI:1326035098
Name:STEPHENS, KAREN SUZANNE (OD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:SUZANNE
Last Name:STEPHENS
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 1:9501 STATE AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66111-1872
Mailing Address - Country:US
Mailing Address - Phone:913-299-7200
Mailing Address - Fax:913-334-4451
Practice Address - Street 1:9501 STATE AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66111-1872
Practice Address - Country:US
Practice Address - Phone:913-299-7200
Practice Address - Fax:913-334-4451
Is Sole Proprietor?:No
Enumeration Date:2005-09-28
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1425-3152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS25423031OtherBLUE CROSS BLUE SHIELD OF KANSAS CITY
KSN437623Medicare PIN
KS25423031OtherBLUE CROSS BLUE SHIELD OF KANSAS CITY
KSU53869Medicare UPIN