Provider Demographics
NPI:1174221642
Name:KARL, RICHARD (ABOC)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:KARL
Suffix:
Gender:M
Credentials:ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:COLEMAN
Mailing Address - State:MI
Mailing Address - Zip Code:48618-9398
Mailing Address - Country:US
Mailing Address - Phone:989-488-7453
Mailing Address - Fax:989-321-4926
Practice Address - Street 1:415 CENTER ST
Practice Address - Street 2:
Practice Address - City:COLEMAN
Practice Address - State:MI
Practice Address - Zip Code:48618-9398
Practice Address - Country:US
Practice Address - Phone:989-488-7453
Practice Address - Fax:989-321-4926
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician