Provider Demographics
NPI:1467411751
Name:DARRELL, KAREN LYNNE (OD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:LYNNE
Last Name:DARRELL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:LYNNE
Other - Last Name:KWIATKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:209 N CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LANDENBERG
Mailing Address - State:PA
Mailing Address - Zip Code:19350-9605
Mailing Address - Country:US
Mailing Address - Phone:610-274-8385
Mailing Address - Fax:
Practice Address - Street 1:57 JENNERS VILLAGE CTR
Practice Address - Street 2:
Practice Address - City:WEST GROVE
Practice Address - State:PA
Practice Address - Zip Code:19390-8102
Practice Address - Country:US
Practice Address - Phone:610-869-4200
Practice Address - Fax:610-869-2511
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2021-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEI30001223152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE654386OtherMEDICARE GROUP PIN
19604OtherMIDATLANTIC
5739408OtherAETNA
5739408OtherAETNA
DE654386OtherMEDICARE GROUP PIN