Healthcare Provider Details

I. General information

NPI: 1477077576
Provider Name (Legal Business Name): STEVEN BENJAMIN KLEIN OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 S CAMP MEADE RD
LINTHICUM MD
21090-2701
US

IV. Provider business mailing address

7202 ROCKLAND HILLS DR UNIT 510
BALTIMORE MD
21209-1152
US

V. Phone/Fax

Practice location:
  • Phone: 410-859-3111
  • Fax:
Mailing address:
  • Phone: 410-371-2557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTA2593
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: