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Individual

MS. KAREN ELAINE MANKO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
O.D.

Contact information

Practice address
2174 DIXIE HWY, FORT MITCHELL, KY 41017-2972
(859) 341-2566
(859) 341-2568
Mailing address
178 PICKETTS CHARGE, FORT THOMAS, KY 41075-1469
(859) 341-2566
(859) 341-2568

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1904DT
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1904DT
STATE LICENSE
KY
05
7100217150
KY
Enumeration date
07/27/2012
Last updated
04/19/2013
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