Provider Demographics
NPI:1295175214
Name:MOUZON, KAREN DENISE (AAS,ABO, LDO)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:DENISE
Last Name:MOUZON
Suffix:
Gender:F
Credentials:AAS,ABO, LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3935 SAVANNAH GROVE RD
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:SC
Mailing Address - Zip Code:29541-6373
Mailing Address - Country:US
Mailing Address - Phone:804-869-1613
Mailing Address - Fax:
Practice Address - Street 1:3935 SAVANNAH GROVE RD
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:SC
Practice Address - Zip Code:29541-6373
Practice Address - Country:US
Practice Address - Phone:804-869-1613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-05
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC829152W00000X
VA1101002876152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist