Active NPI
Karen Ann Pugh, O.D.
- Optometrist
- Granger, IN
National Provider Identifier
1124162607
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 18002419
- Practice address
- 12479 State Road 23
Ste E
Granger, IN 46530-8040 - Phone
- (574) 277-3077
- Fax
- (574) 277-3288
- NPI assigned
- Feb 16, 2007
- Last updated
- Aug 19, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 18002419 | IN | Primary |
Addresses
Primary practice location
12479 State Road 23
Ste E
Granger, IN 46530-8040
Mailing address
5455 Harrison Park LN
Indianapolis, IN 46216-2245
Phone (317) 254-6480
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100474570 | Medicaid | IN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18002419 | IN | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eyecare Indiana II, P.C. | Optometrist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171584000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1376870400000",
"number": "1124162607",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5455 HARRISON PARK LN",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462162245",
"telephone_number": "317-254-6480",
"fax_number": "317-259-8609"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12479 STATE ROAD 23",
"address_2": "STE E",
"city": "GRANGER",
"state": "IN",
"postal_code": "465308040",
"telephone_number": "574-277-3077",
"fax_number": "574-277-3288"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PUGH",
"first_name": "KAREN",
"middle_name": "ANN",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-16",
"last_updated": "2013-08-19",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "IN",
"license": "18002419",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100474570",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Granger, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.