MEDICARE: DR. GARY ALAN KLEIN O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	9621 TPA	CA

General Provider Information

NPI Number	:	1043489081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY ALAN KLEIN O.D.

Provider Business Mailing Address
First Line	:	3788 PARK BLVD
Second Line	:	SUITE 5
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-0910
Country	:	US
Telephone Number	:	619-683-2020
Fax Number	:

Provider Business Practice Location Address
First Line	:	3788 PARK BLVD
Second Line	:	SUITE 5
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-0910
Country	:	US
Telephone Number	:	619-683-2020
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/25/2008
Last Update Date	:	02/25/2008

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