Healthcare Provider Details

I. General information

NPI: 1154663037
Provider Name (Legal Business Name): MICHAEL WADE KLEIN OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2013
Last Update Date: 06/03/2020
Certification Date: 06/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4741 S COCHISE DRVIE
INDEPENDENCE MO
64055
US

IV. Provider business mailing address

4801 S CLIFF AVE STE 100
INDEPENDENCE MO
64055-6954
US

V. Phone/Fax

Practice location:
  • Phone: 816-478-1230
  • Fax: 816-478-4413
Mailing address:
  • Phone: 816-350-4536
  • Fax: 816-350-4585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2013020017
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: