Basic Information
| Provider Information | |||||||||
| NPI: | 1205022266 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | KLEIN VISION GROUP, PLLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SPRING KLEIN VISION CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6603 FM 2920 | ||||||||
| Address2: | |||||||||
| City: | SPRING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773793307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2813704444 | ||||||||
| FaxNumber: | 2813202012 | ||||||||
| Practice Location | |||||||||
| Address1: | 6603 FM 2920 | ||||||||
| Address2: | |||||||||
| City: | SPRING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773793307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2813704444 | ||||||||
| FaxNumber: | 2813202012 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2007 | ||||||||
| LastUpdateDate: | 04/12/2013 | ||||||||
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| AuthorizedOfficialLastName: | WAY | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | MATTHEW | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2813704444 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | O.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 6423TG | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 181511001 | 05 | TX | MEDICAID |