Individual
KARSEN HISE MAXWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
777 TANGLEFOOT LN, BETTENDORF, IA 52722-1650
(563) 323-2020
(563) 328-5699
Mailing address
777 TANGLEFOOT LN, BETTENDORF, IA 52722-1650
(563) 323-2020
(563) 328-5699
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
046.011915
IL
152W00000X
Optometrist
Primary
126421
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
046.011915
ILLINOIS STATE MEDICAL BOARD
IL
01
—
10901
TEXAS OPTOMETRY BOARD
TX
01
—
126421
IOWA STATE MEDICAL BOARD
IA
Enumeration date
06/22/2023
Last updated
09/23/2024
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