Healthcare Provider Details

I. General information

NPI: 1215627732
Provider Name (Legal Business Name): JENNIFER KLEYN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2023
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

597 BALDWIN ST STE 1
JENISON MI
49428-7994
US

IV. Provider business mailing address

597 BALDWIN ST STE 1
JENISON MI
49428-7994
US

V. Phone/Fax

Practice location:
  • Phone: 616-457-0760
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901005678
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: