Provider Demographics
NPI:1619087079
Name:SEFFENS, KARYN R (OD)
Entity Type:Individual
Prefix:DR
First Name:KARYN
Middle Name:R
Last Name:SEFFENS
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 1:40855 MANOR HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-6519
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:869 JOHN MARSHALL HWY
Practice Address - Street 2:
Practice Address - City:FRONT ROYAL
Practice Address - State:VA
Practice Address - Zip Code:22630-4578
Practice Address - Country:US
Practice Address - Phone:540-635-3223
Practice Address - Fax:540-635-1050
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCOP10000164152W00000X
VA0618001559152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010272157Medicaid
VA010273897Medicaid
VA010273846Medicaid
VA010273889Medicaid