Provider Demographics
NPI:1780786046
Name:KARR, JENNIFER M (OD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:KARR
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 1:3717 NAMEOKI RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:GRANITE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62040-3720
Mailing Address - Country:US
Mailing Address - Phone:618-876-2438
Mailing Address - Fax:618-876-2440
Practice Address - Street 1:3717 NAMEOKI RD
Practice Address - Street 2:SUITE B
Practice Address - City:GRANITE CITY
Practice Address - State:IL
Practice Address - Zip Code:62040-3720
Practice Address - Country:US
Practice Address - Phone:618-876-2438
Practice Address - Fax:618-876-2440
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009717152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL214954OtherMEDICARE GROUP PIN
IL046009717Medicaid
ILV03939Medicare UPIN
IL214954OtherMEDICARE GROUP PIN
IL046009717Medicaid