Provider Demographics
NPI:1629083092
Name:BOUSCHER, KAREN L (OD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:L
Last Name:BOUSCHER
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 1:222 E SMOKERISE DR
Mailing Address - Street 2:WALMART VISION CENTER
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-8277
Mailing Address - Country:US
Mailing Address - Phone:330-336-5301
Mailing Address - Fax:330-336-5308
Practice Address - Street 1:222 E SMOKERISE DR
Practice Address - Street 2:WALMART VISION CENTER
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-8277
Practice Address - Country:US
Practice Address - Phone:330-336-5301
Practice Address - Fax:330-336-5308
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4426/T1017152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHU43357Medicare UPIN
OHDA0778043Medicare ID - Type Unspecified