Provider Demographics
NPI:1174644892
Name:KLEIN, JIL (OD)
Entity Type:Individual
Prefix:DR
First Name:JIL
Middle Name:
Last Name:KLEIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1504 S SALISBURY BLVD
Mailing Address - Street 2:1504 #20 S. SALISBURY BLVD.
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-7165
Mailing Address - Country:US
Mailing Address - Phone:410-334-3900
Mailing Address - Fax:410-334-3955
Practice Address - Street 1:1504 #20 S. SALISBURY BLVD.
Practice Address - Street 2:COURT PLAZA
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804
Practice Address - Country:US
Practice Address - Phone:410-334-3900
Practice Address - Fax:410-334-3955
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1384152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR5850001OtherFEDERALBLUECROSSBLUESHIE
MD54699105OtherBLUECROSSBLUESHIELD
MD3116528OtherUNITEDHEALTHCARE
MD562M871FMedicare ID - Type Unspecified
T81500Medicare UPIN