Provider Demographics
NPI:1023344835
Name:BASSETT, KARYN (OD)
Entity type:Individual
Prefix:DR
First Name:KARYN
Middle Name:
Last Name:BASSETT
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 1:1600 N SR 50
Mailing Address - Street 2:PEARLE VISION
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-9307
Mailing Address - Country:US
Mailing Address - Phone:815-935-0404
Mailing Address - Fax:815-935-0489
Practice Address - Street 1:1600 N SR 50
Practice Address - Street 2:PEARLE VISION
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-9307
Practice Address - Country:US
Practice Address - Phone:815-935-0404
Practice Address - Fax:815-935-0489
Is Sole Proprietor?:No
Enumeration Date:2009-10-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.010299152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL579270059Medicare PIN