Provider Demographics
NPI:1770560286
Name:SKURNER, KAREN S (OD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:S
Last Name:SKURNER
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 1:9202 N MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1800
Mailing Address - Country:US
Mailing Address - Phone:317-841-2020
Mailing Address - Fax:317-570-7433
Practice Address - Street 1:5091 W BETHEL AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-8511
Practice Address - Country:US
Practice Address - Phone:317-841-2020
Practice Address - Fax:317-570-7433
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002725A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200041180Medicaid
IN151560DDDMedicare PIN
IN410044645Medicare PIN
U53158Medicare UPIN
IN176220AMedicare PIN
IN410044645Medicare PIN
OH2223552Medicaid