Provider Demographics
NPI:1154663037
Name:KLEIN, MICHAEL WADE (OD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:WADE
Last Name:KLEIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4801 S CLIFF AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-6954
Mailing Address - Country:US
Mailing Address - Phone:816-350-4536
Mailing Address - Fax:816-350-4585
Practice Address - Street 1:4741 S COCHISE DRVIE
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055
Practice Address - Country:US
Practice Address - Phone:816-478-1230
Practice Address - Fax:816-478-4413
Is Sole Proprietor?:No
Enumeration Date:2013-03-19
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013020017152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist