Provider Demographics
NPI:1124162607
Name:PUGH, KAREN ANN (OD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:ANN
Last Name:PUGH
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 1:5455 HARRISON PARK LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46216-2245
Mailing Address - Country:US
Mailing Address - Phone:317-254-6480
Mailing Address - Fax:317-259-8609
Practice Address - Street 1:12479 STATE ROAD 23
Practice Address - Street 2:STE E
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-8040
Practice Address - Country:US
Practice Address - Phone:574-277-3077
Practice Address - Fax:574-277-3288
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002419152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100474570Medicaid
IN666110001Medicare PIN