Provider Demographics
NPI:1790553295
Name:WELDON, KARSEN LEE (OD)
Entity Type:Individual
Prefix:
First Name:KARSEN
Middle Name:LEE
Last Name:WELDON
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 1:18882 MALLERY RD
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-6739
Mailing Address - Country:US
Mailing Address - Phone:317-379-9306
Mailing Address - Fax:
Practice Address - Street 1:8702 KEYSTONE XING STE 101B
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-7811
Practice Address - Country:US
Practice Address - Phone:317-975-6900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-13
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18004455A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist