Provider Demographics
NPI:1346211679
Name:CANUPP, KAREN M (OD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:M
Last Name:CANUPP
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:KAREN
Other - Middle Name:LEE
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:90 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:WINDER
Mailing Address - State:GA
Mailing Address - Zip Code:30680-1714
Mailing Address - Country:US
Mailing Address - Phone:770-867-2505
Mailing Address - Fax:770-867-8668
Practice Address - Street 1:90 CHURCH ST
Practice Address - Street 2:
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680-1714
Practice Address - Country:US
Practice Address - Phone:770-867-2505
Practice Address - Fax:770-867-8668
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1610152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00796232BMedicaid
U67227Medicare UPIN
GA0590190001Medicare NSC
GA41ZCDJNMedicare ID - Type Unspecified