MEDICARE: DR. KENNETH H KLING 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
1	152W00000X	Optometrist	2987T518	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	03180	OTHER	OH	PARAMOUNT
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	003304	OTHER	OH	VISION SERVICE PLAN

General Provider Information

NPI Number	:	1649276528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH H KLING O.D.

Provider Business Mailing Address
First Line	:	PO BOX 374
Second Line	:
City	:	WAUSEON
State	:	OH
Zip	:	43567-0374
Country	:	US
Telephone Number	:	419-335-3055
Fax Number	:	419-335-3065

Provider Business Practice Location Address
First Line	:	1162 N SHOOP AVE
Second Line	:
City	:	WAUSEON
State	:	OH
Zip	:	43567-1818
Country	:	US
Telephone Number	:	419-335-3055
Fax Number	:	419-335-3065

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	10/19/2011

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