Healthcare Provider Details

I. General information

NPI: 1417171588
Provider Name (Legal Business Name): DR. JIL KLEIN - OCEAN PINES VISION CARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 09/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11002 MANKLIN MEADOW LANE SUITE 6
OCEAN PINES MD
21811
US

IV. Provider business mailing address

11002 MANKLIN MEADOW LANE SUITE 6
OCEAN PINES MD
21811
US

V. Phone/Fax

Practice location:
  • Phone: 410-208-4949
  • Fax: 410-208-4955
Mailing address:
  • Phone: 410-208-4949
  • Fax: 410-208-4955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberTA1384
License Number StateMD

VIII. Authorized Official

Name: DR. JIL KLEIN
Title or Position: PRESIDENT
Credential: O.D.
Phone: 410-208-4949