Provider Demographics
NPI:1477607877
Name:BUCKNALL, KARLA ENOCHSON (OD)
Entity Type:Individual
Prefix:DR
First Name:KARLA
Middle Name:ENOCHSON
Last Name:BUCKNALL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:KARLA
Other - Middle Name:JOY
Other - Last Name:ENOCHSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:7345 PINON JAY CIR
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-9022
Mailing Address - Country:US
Mailing Address - Phone:605-343-8008
Mailing Address - Fax:
Practice Address - Street 1:3200 CANYON LAKE DR
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-8114
Practice Address - Country:US
Practice Address - Phone:605-355-2282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD471152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist