Provider Demographics
NPI:1598952897
Name:KAREN S WOLF OD & GIL HOUSTON OD PA
Entity Type:Organization
Organization Name:KAREN S WOLF OD & GIL HOUSTON OD PA
Other - Org Name:PONTE VEDRA EYE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:S
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:904-285-8448
Mailing Address - Street 1:150 PROFESSIONAL DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-7231
Mailing Address - Country:US
Mailing Address - Phone:904-285-8448
Mailing Address - Fax:904-285-3410
Practice Address - Street 1:150 PROFESSIONAL DR
Practice Address - Street 2:SUITE 300
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-7231
Practice Address - Country:US
Practice Address - Phone:904-285-8448
Practice Address - Fax:904-285-3410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2406152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL33495Medicare UPIN
FL0664110001Medicare NSC