Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 4785 | OH |
NPI | 1013060748 |
---|---|
Provider Name | Dr. Karen Lynn Wallo |
First Address | Berea, OH 44017-1057 |
Second Address | Parma, OH 44129-5516 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2007 |
Last Update Date | 08/07/2007 |