Provider Demographics
NPI:1154461432
Name:GEORGE W. KLEDARAS, O.D., P.A.
Entity Type:Organization
Organization Name:GEORGE W. KLEDARAS, O.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:W
Authorized Official - Last Name:KLEDARAS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:302-764-4613
Mailing Address - Street 1:230 PHILADELPHIA PIKE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19809-3125
Mailing Address - Country:US
Mailing Address - Phone:302-764-4613
Mailing Address - Fax:302-764-3201
Practice Address - Street 1:230 PHILADELPHIA PIKE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19809-3125
Practice Address - Country:US
Practice Address - Phone:302-764-4613
Practice Address - Fax:302-764-3201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEI30001166152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000172422Medicaid
DE173454Medicare UPIN
DET73254Medicare UPIN