Provider Demographics
NPI:1659372365
Name:GRIFFITH, KAREN ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:ANN
Last Name:GRIFFITH
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 1:320 PETALUMA BLVD S
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-4245
Mailing Address - Country:US
Mailing Address - Phone:707-762-8643
Mailing Address - Fax:707-762-3554
Practice Address - Street 1:320 PETALUMA BLVD S
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-4245
Practice Address - Country:US
Practice Address - Phone:707-762-8643
Practice Address - Fax:707-762-3554
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9002T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1431322Medicaid
U11216Medicare UPIN
CA0486150001Medicare NSC
CASD0090020Medicare PIN