Provider Demographics
NPI:1891887154
Name:WILSON, KAREN BORCHMAN (OD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:BORCHMAN
Last Name:WILSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:KAREN
Other - Middle Name:LYN
Other - Last Name:BORCHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:988102 NEBRASKA MEDICAL CTR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68198-8102
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3902 LEAVENWORTH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-0003
Practice Address - Country:US
Practice Address - Phone:402-559-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1145152WL0500X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1145OtherNEBR LICENSE
MW0566262OtherDEA
IA1003821422Medicaid
NE37072OtherBCBS
NENA1057001OtherMEDICARE PTAN
NE10025369100Medicaid
NE10025382400Medicaid
NE37072OtherBCBS
U81626Medicare UPIN