Provider Demographics
NPI:1518950278
Name:WHARTON, KAREN RENEE (OD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:RENEE
Last Name:WHARTON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11684 RANCH ELSIE RD
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80403-7307
Mailing Address - Country:US
Mailing Address - Phone:303-642-3117
Mailing Address - Fax:303-444-6560
Practice Address - Street 1:1692 30TH ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1034
Practice Address - Country:US
Practice Address - Phone:303-449-0857
Practice Address - Fax:303-444-6560
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1192152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO387228Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE NUMBE
CO4506580001Medicare NSC
COT60856Medicare UPIN