Provider Demographics
NPI:1841766003
Name:POPOVICH, KAREN STACY
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:STACY
Last Name:POPOVICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 ARTHUR MINNIS RD
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NC
Mailing Address - Zip Code:27278-9314
Mailing Address - Country:US
Mailing Address - Phone:919-942-5217
Mailing Address - Fax:
Practice Address - Street 1:614 ARTHUR MINNIS RD
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NC
Practice Address - Zip Code:27278-9314
Practice Address - Country:US
Practice Address - Phone:919-942-5217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-15
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC09079183500000X
NC9500425207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No183500000XPharmacy Service ProvidersPharmacist