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General NPI Number Information
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NPI Number | 1972789030
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Entity Type | Organization
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Legal Business Name | JAY B KLEIN OD PA
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Dates
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Enumeration Date | 01/18/2008
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Last Update Date | 12/02/2016
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Provider Practice Location Address
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Address Line | 924 CANDLELIGHT BLVD
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City | BROOKSVILLE
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State | FL
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Zip | 34601-3116
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Country | US
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Telephone | 352-796-4833
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Fax | 352-799-0462
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Provider Business Mailing Address
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Address Line | 924 CANDLELIGHT BLVD
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City | BROOKSVILLE
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State | FL
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Zip | 34601-3116
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Country | US
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Telephone | 352-796-4833
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Fax | 352-799-0462
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAY B KLEIN
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Credential | O.D.
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Telephone | 352-796-4833
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | OPC1805
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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