Provider Demographics
NPI:1548660517
Name:HAFFORD, KARLA (OD)
Entity type:Individual
Prefix:
First Name:KARLA
Middle Name:
Last Name:HAFFORD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 207158
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-7158
Mailing Address - Country:US
Mailing Address - Phone:636-200-4393
Mailing Address - Fax:636-527-0766
Practice Address - Street 1:3122 S GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63118-1012
Practice Address - Country:US
Practice Address - Phone:314-450-7313
Practice Address - Fax:314-450-7314
Is Sole Proprietor?:No
Enumeration Date:2014-08-27
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002875152W00000X
MO2019042773152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
A19590OtherEYEMED ID
NM93237049Medicaid
375054ZKH4Medicare PIN