Provider Demographics
NPI:1386618338
Name:LEDGERWOOD, KAREN R (OD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:R
Last Name:LEDGERWOOD
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 1:502 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47933-1812
Mailing Address - Country:US
Mailing Address - Phone:765-362-8606
Mailing Address - Fax:765-362-8779
Practice Address - Street 1:502 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CRAWFORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47933-1812
Practice Address - Country:US
Practice Address - Phone:765-362-8606
Practice Address - Fax:765-362-8779
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002826A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0388410001Medicare NSC
INU63474Medicare UPIN
IN556910BMedicare ID - Type Unspecified