Provider Demographics
NPI:1184621872
Name:PRIBORSKY, KARI L (OD)
Entity type:Individual
Prefix:MRS
First Name:KARI
Middle Name:L
Last Name:PRIBORSKY
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:PO BOX 444
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72654-0444
Mailing Address - Country:US
Mailing Address - Phone:870-424-4900
Mailing Address - Fax:
Practice Address - Street 1:2943 HIGHWAY 62 W
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-6535
Practice Address - Country:US
Practice Address - Phone:870-424-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2507152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR140803722Medicaid
410045203OtherPALMETTA GBA - RAILROAD MEDICARE
AR0352090001Medicare NSC
410045203OtherPALMETTA GBA - RAILROAD MEDICARE
U78486Medicare UPIN
AR140803722Medicaid
496576942Medicare PIN