MEDICARE: DR. MILETE CLARK KLINKERMAN 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	5412TG	TX

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	:	1942344452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MILETE CLARK KLINKERMAN O.D.

Provider Business Mailing Address
First Line	:	2855 GRAMERCY ST # 400
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77025-1756
Country	:	US
Telephone Number	:	713-668-6828
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 GULF FWY S STE 114
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-5148
Country	:	US
Telephone Number	:	281-338-4497
Fax Number	:

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

Provider Enumeration Date	:	02/16/2007
Last Update Date	:	03/30/2021

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