Basic Information
| Provider Information | |||||||||
| NPI: | 1619087079 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SEFFENS | ||||||||
| FirstName: | KARYN | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 40855 MANOR HOUSE RD | ||||||||
| Address2: | |||||||||
| City: | LEESBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201756519 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 869 JOHN MARSHALL HWY | ||||||||
| Address2: | |||||||||
| City: | FRONT ROYAL | ||||||||
| State: | VA | ||||||||
| PostalCode: | 226304578 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5406353223 | ||||||||
| FaxNumber: | 5406351050 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 01/24/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OP10000164 | DC | N | Eye and Vision Services Providers | Optometrist | 152W00000X | 0618001559 | VA | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 010272157 | 05 | VA | MEDICAID | 010273897 | 05 | VA | MEDICAID | 010273846 | 05 | VA | MEDICAID | 010273889 | 05 | VA | MEDICAID |