MEDICARE: LYNETTE KLINE 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336432822
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LYNETTE KLINE O.D.

Provider Business Mailing Address
First Line	:	205 E PINE ST
Second Line	:
City	:	FORT BRAGG
State	:	CA
Zip	:	95437-3306
Country	:	US
Telephone Number	:	707-961-1037
Fax Number	:	707-961-0894

Provider Business Practice Location Address
First Line	:	205 E PINE ST
Second Line	:
City	:	FORT BRAGG
State	:	CA
Zip	:	95437-3306
Country	:	US
Telephone Number	:	707-961-1037
Fax Number	:	707-961-0894

Authorized Official
Title or Position	:	DR./OWNER
Name	:	DR. LYNETTE M KLINE
Credential	:	O,D.
Telephone Number	:	707-961-1037

Provider Enumeration Date	:	05/17/2011
Last Update Date	:	05/17/2011

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