Provider Demographics
NPI:1801824289
Name:HAWK, KAREN (OD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:
Last Name:HAWK
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 1:3333 VICTORIA ISLAND CT
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-5942
Mailing Address - Country:US
Mailing Address - Phone:916-208-4389
Mailing Address - Fax:916-208-4389
Practice Address - Street 1:610 COTTONWOOD ST
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-3615
Practice Address - Country:US
Practice Address - Phone:530-666-0333
Practice Address - Fax:530-666-0352
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT11060152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU74989Medicare UPIN
CASD0110601Medicare ID - Type Unspecified