Provider Demographics
NPI:1861401721
Name:HASSELBRINCK, KARYN CONWAY (OD)
Entity type:Individual
Prefix:DR
First Name:KARYN
Middle Name:CONWAY
Last Name:HASSELBRINCK
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 1:3535 PINECREST RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46234-1417
Mailing Address - Country:US
Mailing Address - Phone:317-290-8460
Mailing Address - Fax:
Practice Address - Street 1:4020 LAFAYETTE RD.
Practice Address - Street 2:DR. H. HUBBARD AND ASSOCIATES P.C.
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254
Practice Address - Country:US
Practice Address - Phone:317-293-9314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002677A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INU24226Medicare UPIN
IN135260BMedicare ID - Type Unspecified