Basic Information
| Provider Information | |||||||||
| NPI: | 1710953161 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KLINGE | ||||||||
| FirstName: | THERESA | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7450 FRANCE AVE S | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | EDINA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554354787 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9528328100 | ||||||||
| FaxNumber: | 9528328176 | ||||||||
| Practice Location | |||||||||
| Address1: | 7450 FRANCE AVE S | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | EDINA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554354787 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9528328100 | ||||||||
| FaxNumber: | 9528328176 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 2664 | MN | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 960561043682 | 01 | MN | PREFERREDONE | OTHER | 2202876 | 01 | MN | MEDICA | OTHER | 0800014 | 01 | MN | MEDICA DUEL SOLUTIONS | OTHER | P00232837 | 01 | MN | RR MEDICARE | OTHER | 2349336 | 01 | MN | AMERICA'S PPO/TPA | OTHER | 381M8KL | 01 | MN | BLUE CROSS BLUE SHIELD | OTHER |