Provider Demographics
NPI:1760466775
Name:VANBUSKIRK, KAARYN PEDERSON (OD)
Entity Type:Individual
Prefix:DR
First Name:KAARYN
Middle Name:PEDERSON
Last Name:VANBUSKIRK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MRS
Other - First Name:KAARYN
Other - Middle Name:
Other - Last Name:VAN BUSKIRK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:4860 Y ST
Mailing Address - Street 2:SUITE 2400
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2307
Mailing Address - Country:US
Mailing Address - Phone:916-734-7851
Mailing Address - Fax:916-734-6197
Practice Address - Street 1:4860 Y ST
Practice Address - Street 2:SUITE 2400
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2307
Practice Address - Country:US
Practice Address - Phone:916-734-7851
Practice Address - Fax:916-734-6197
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT1205T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU77274Medicare UPIN