Provider Demographics
NPI:1760405955
Name:KING, KAREN L (OD)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:L
Last Name:KING
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:BARBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:109 HALESWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-7081
Mailing Address - Country:US
Mailing Address - Phone:843-764-1770
Mailing Address - Fax:
Practice Address - Street 1:216 SAINT JAMES AVE STE F
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-3085
Practice Address - Country:US
Practice Address - Phone:843-718-2020
Practice Address - Fax:843-718-1283
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1296152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD12966Medicaid