Provider Demographics
NPI:1881698504
Name:MUNSON, KAROLINE L (O D)
Entity type:Individual
Prefix:
First Name:KAROLINE
Middle Name:L
Last Name:MUNSON
Suffix:
Gender:F
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 JETT BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-7778
Mailing Address - Country:US
Mailing Address - Phone:502-695-6310
Mailing Address - Fax:502-695-6311
Practice Address - Street 1:111 JETT BLVD STE 100
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-7778
Practice Address - Country:US
Practice Address - Phone:502-695-6310
Practice Address - Fax:502-695-6311
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2025-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1520DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000280798OtherANTHEM
KYP00021169OtherRAILROAD MEDICARE
KY77000420Medicaid
KY77000420Medicaid
KY000000280798OtherANTHEM
KYU86690Medicare UPIN