MEDICARE: LINDSAY KATHARINE KLUMPP 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	4901004857	MI

General Provider Information

NPI Number	:	1174923189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDSAY KATHARINE KLUMPP O.D.

Provider Business Mailing Address
First Line	:	850 W NORTH ST
Second Line	:	STE. 100
City	:	JACKSON
State	:	MI
Zip	:	49202-3196
Country	:	US
Telephone Number	:	877-852-8463
Fax Number	:

Provider Business Practice Location Address
First Line	:	850 W NORTH ST
Second Line	:	STE. 100
City	:	JACKSON
State	:	MI
Zip	:	49202-3196
Country	:	US
Telephone Number	:	877-852-8463
Fax Number	:

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

Provider Enumeration Date	:	08/27/2014
Last Update Date	:	12/21/2015

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