Provider Demographics
NPI:1801949680
Name:DR. KAREN ANDERSON PC
Entity type:Organization
Organization Name:DR. KAREN ANDERSON PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:P
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:641-357-2020
Mailing Address - Street 1:14 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEAR LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:50428-1712
Mailing Address - Country:US
Mailing Address - Phone:641-357-2020
Mailing Address - Fax:641-357-7149
Practice Address - Street 1:14 N 8TH ST
Practice Address - Street 2:
Practice Address - City:CLEAR LAKE
Practice Address - State:IA
Practice Address - Zip Code:50428-1712
Practice Address - Country:US
Practice Address - Phone:641-357-2020
Practice Address - Fax:641-357-7149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02045152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1132977Medicaid
IA52894Medicare ID - Type Unspecified
IA1132977Medicaid
IA6165960001Medicare NSC