Basic Information
Provider Information
NPI: 1124177183
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DARKENWALD
FirstName: KAREN
MiddleName: LYNN
NamePrefix: DR.
NameSuffix:  
Credential: O.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1650 RESPONSE RD
Address2:  
City: SACRAMENTO
State: CA
PostalCode: 958154807
CountryCode: US
TelephoneNumber: 9166144015
FaxNumber:  
Practice Location
Address1: 1650 RESPONSE RD
Address2: OPTOMETRY DEPT.
City: SACRAMENTO
State: CA
PostalCode: 958154807
CountryCode: US
TelephoneNumber: 9166144015
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/09/2007
LastUpdateDate: 01/27/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/27/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
152W00000X8449TCAY Eye and Vision Services ProvidersOptometrist 

No ID Information.


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