Provider Demographics
NPI:1306891361
Name:MATTSON, KARI CARPENTER I (OD)
Entity type:Individual
Prefix:DR
First Name:KARI
Middle Name:CARPENTER
Last Name:MATTSON
Suffix:I
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:251 LARUE
Mailing Address - Street 2:APT 109
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-8317
Mailing Address - Country:US
Mailing Address - Phone:859-312-2793
Mailing Address - Fax:859-273-4582
Practice Address - Street 1:4051 NICHOLASVILLE RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-4432
Practice Address - Country:US
Practice Address - Phone:859-272-1422
Practice Address - Fax:859-273-4582
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1455DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77000040Medicaid
KY000000360204OtherBLUE CROSS BLUE SHIELD
KY000000360204OtherBLUE CROSS BLUE SHIELD