Provider Demographics
NPI:1265767107
Name:MAK, KAREN (OD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:
Last Name:MAK
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 1:212 MARET RD
Mailing Address - Street 2:
Mailing Address - City:TOWNVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29689
Mailing Address - Country:US
Mailing Address - Phone:678-327-5457
Mailing Address - Fax:
Practice Address - Street 1:100 COUNTRY CLUB LN
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29625-1717
Practice Address - Country:US
Practice Address - Phone:864-224-5783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-09
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002560152W00000X
SC1616152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist