Provider Demographics
NPI:1588759112
Name:HEALY, KAREN D (OD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:D
Last Name:HEALY
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 1:99 US ROUTE 1 BYP
Mailing Address - Street 2:SUITE A
Mailing Address - City:KITTERY
Mailing Address - State:ME
Mailing Address - Zip Code:03904-1570
Mailing Address - Country:US
Mailing Address - Phone:207-439-0410
Mailing Address - Fax:207-439-8353
Practice Address - Street 1:99 US ROUTE 1 BYP
Practice Address - Street 2:SUITE A
Practice Address - City:KITTERY
Practice Address - State:ME
Practice Address - Zip Code:03904-1570
Practice Address - Country:US
Practice Address - Phone:207-439-0410
Practice Address - Fax:207-439-8353
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT768152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME242040099Medicaid
NH30005020Medicaid
MEMM3301Medicare ID - Type Unspecified
NH30005020Medicaid