Provider Demographics
NPI:1851326623
Name:HERMAN, KAREN LEE (OD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:LEE
Last Name:HERMAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:LEE
Other - Last Name:KROHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1402 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMER
Mailing Address - State:WI
Mailing Address - Zip Code:54724-1637
Mailing Address - Country:US
Mailing Address - Phone:715-568-1373
Mailing Address - Fax:
Practice Address - Street 1:1402 MAIN ST
Practice Address - Street 2:
Practice Address - City:BLOOMER
Practice Address - State:WI
Practice Address - Zip Code:54724-1637
Practice Address - Country:US
Practice Address - Phone:715-568-1373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3016-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38627600Medicaid
000047940OtherMEDICARE PTAN
WIV00977Medicare UPIN