Provider Demographics
NPI:1568429876
Name:FROMBACH, KAREN ELIZABETH (OD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ELIZABETH
Last Name:FROMBACH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:ELIZABETH
Other - Last Name:GRANY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:570 DOVER CENTER RD
Mailing Address - Street 2:
Mailing Address - City:BAY VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44140-2361
Mailing Address - Country:US
Mailing Address - Phone:440-871-1139
Mailing Address - Fax:440-871-0222
Practice Address - Street 1:570 DOVER CENTER RD
Practice Address - Street 2:
Practice Address - City:BAY VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44140-2361
Practice Address - Country:US
Practice Address - Phone:440-871-1139
Practice Address - Fax:440-871-0222
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5211/T25115152W00000X
OH5211152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2259596Medicaid
OHU85364Medicare UPIN
OHFR7350961Medicare PIN