Provider Demographics
NPI:1386217503
Name:ALLEN, KAREN KAY (OPTICIAN)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:KAY
Last Name:ALLEN
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 63
Mailing Address - Street 2:
Mailing Address - City:WAUNETA
Mailing Address - State:NE
Mailing Address - Zip Code:69045-0063
Mailing Address - Country:US
Mailing Address - Phone:308-394-5111
Mailing Address - Fax:308-394-5111
Practice Address - Street 1:308 N TECUMSEH STE 2
Practice Address - Street 2:
Practice Address - City:WAUNETA
Practice Address - State:NE
Practice Address - Zip Code:69045-9501
Practice Address - Country:US
Practice Address - Phone:308-394-5111
Practice Address - Fax:308-394-5111
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-24
Last Update Date:2021-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE171162156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEH12368166Medicaid
NE87-1091622Medicaid