MEDICARE: DR. MICHAEL WALTER 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	046-007659	IL
2	152W00000X	Optometrist	OPT002155	GA
3	152W00000X	Optometrist	2012011384	MO

General Provider Information

NPI Number	:	1689680886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL WALTER KLINE O.D.

Provider Business Mailing Address
First Line	:	4200 RUSTY RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63128-1973
Country	:	US
Telephone Number	:	314-894-7951
Fax Number	:	314-894-7977

Provider Business Practice Location Address
First Line	:	4200 RUSTY RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63128-1973
Country	:	US
Telephone Number	:	314-894-7951
Fax Number	:	314-894-7977

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

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	08/12/2012

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