Provider Demographics
NPI:1558374074
Name:WRIGLEY-HAAK, KAREN MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:MARIE
Last Name:WRIGLEY-HAAK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:KAREN
Other - Middle Name:M,
Other - Last Name:WRIGLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:1919 CHESTNUT ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-3401
Mailing Address - Country:US
Mailing Address - Phone:215-563-8440
Mailing Address - Fax:215-567-4993
Practice Address - Street 1:1919 CHESTNUT ST
Practice Address - Street 2:SUITE 105
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-3401
Practice Address - Country:US
Practice Address - Phone:215-563-8440
Practice Address - Fax:215-567-4993
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000841152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA450869OtherHIGHMARK BLUE SHIELD
PA0062425000OtherINDEPENDENCE BLUE SHIELD
PA450869RUCMedicare PIN
PA450869TWLMedicare PIN
PA0062425000OtherINDEPENDENCE BLUE SHIELD