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General NPI Number Information
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NPI Number | 1366573289
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Entity Type | Organization
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Legal Business Name | PETER S. KLEM, OD
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Dates
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Enumeration Date | 03/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3493 TAYLOR RD
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City | LOOMIS
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State | CA
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Zip | 95650
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Country | US
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Telephone | 916-652-0449
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Fax | 916-660-9156
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Provider Business Mailing Address
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Address Line | PO BOX 508
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City | LOOMIS
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State | CA
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Zip | 95650-0508
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Country | US
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Telephone | 916-652-0449
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Fax | 916-660-9156
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Authorized Official
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Title or Position | OWNER
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Name | PETER SHERMAN KLEM
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Credential | OD
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Telephone | 29166520449
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 6478T
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License Number State | CA
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