Provider Demographics
NPI:1568155190
Name:CHISHOLM, KAREN LOUISE (OD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:LOUISE
Last Name:CHISHOLM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4582 CHESHIRE ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-4021
Mailing Address - Country:US
Mailing Address - Phone:619-302-3903
Mailing Address - Fax:
Practice Address - Street 1:2100 VISTA WAY
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-5600
Practice Address - Country:US
Practice Address - Phone:760-966-0026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35450152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist