Provider Demographics
NPI:1619994373
Name:ALDRIDGE, KAREN S (OD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:S
Last Name:ALDRIDGE
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 1:302 N POMEROY ST
Mailing Address - Street 2:
Mailing Address - City:HILL CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67642-1720
Mailing Address - Country:US
Mailing Address - Phone:785-421-3406
Mailing Address - Fax:785-421-5547
Practice Address - Street 1:302 N POMEROY ST
Practice Address - Street 2:
Practice Address - City:HILL CITY
Practice Address - State:KS
Practice Address - Zip Code:67642-1720
Practice Address - Country:US
Practice Address - Phone:785-421-3406
Practice Address - Fax:785-421-5547
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1369152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100219390AMedicaid
KSU35492Medicare UPIN
KSKA3091Medicare PIN
KS0647760001Medicare NSC
KS651128Medicare PIN
KS100219390AMedicaid