Healthcare Provider Details

I. General information

NPI: 1396732632
Provider Name (Legal Business Name): ADAM B KLEMENS OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 02/04/2026
Certification Date: 02/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

483 N AVIATION BLVD
EL SEGUNDO CA
90245-2808
US

IV. Provider business mailing address

483 N AVIATION BLVD
EL SEGUNDO CA
90245-2808
US

V. Phone/Fax

Practice location:
  • Phone: 310-653-6163
  • Fax:
Mailing address:
  • Phone: 310-653-6163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2503
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: