Basic Information
| Provider Information | |||||||||
| NPI: | 1598760894 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KLEINAU | ||||||||
| FirstName: | KARL | ||||||||
| MiddleName: | JURGEN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6035 FAIRVIEW RD | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282103256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042953000 | ||||||||
| FaxNumber: | 7048388494 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 PARK ST | ||||||||
| Address2: | |||||||||
| City: | BELMONT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280123368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042953700 | ||||||||
| FaxNumber: | 7042953707 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2005 | ||||||||
| LastUpdateDate: | 01/29/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 1392 | NC | Y | Eye and Vision Services Providers | Optometrist | 152W00000X | 1165 | SC | N | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 5107023 | 01 | NC | AETNA | OTHER | DN1392 | 05 | SC | MEDICAID | NC1392 | 01 | NC | EYEMED | OTHER | 0905R | 01 | NC | BCBS OF NORTH CAROLINA | OTHER | 2241738 | 01 | NC | UNITED HEALTHCARE | OTHER | 20096067 | 01 | SC | SELECT HEALTH OF SC | OTHER | 890905R | 05 | NC | MEDICAID |