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NPI Code Detail

MEDICARE: DR. KARL JURGEN KLEINAU O.D.

MEDICARE:  DR. KARL JURGEN KLEINAU  O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist1392NC
2152W00000XOptometrist1165SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15107023OTHERNCAETNA
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3NC1392OTHERNCEYEMED
40905ROTHERNCBCBS OF NORTH CAROLINA
52241738OTHERNCUNITED HEALTHCARE
620096067OTHERSCSELECT HEALTH OF SC
7MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1598760894
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KARL JURGEN KLEINAU O.D.
Provider Business Mailing Address
First Line : 6035 FAIRVIEW RD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28210-3256
Country : US
Telephone Number : 704-295-3000
Fax Number : 704-838-8494
Provider Business Practice Location Address
First Line : 400 PARK ST
Second Line :
City : BELMONT
State : NC
Zip : 28012-3368
Country : US
Telephone Number : 704-295-3700
Fax Number : 704-295-3707
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2005
Last Update Date : 01/29/2010

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