Provider Demographics
NPI:1205022266
Name:KLEIN VISION GROUP, PLLC
Entity Type:Organization
Organization Name:KLEIN VISION GROUP, PLLC
Other - Org Name:SPRING KLEIN VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:WAY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:281-370-4444
Mailing Address - Street 1:6603 FM 2920
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-3307
Mailing Address - Country:US
Mailing Address - Phone:281-370-4444
Mailing Address - Fax:281-320-2012
Practice Address - Street 1:6603 FM 2920
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-3307
Practice Address - Country:US
Practice Address - Phone:281-370-4444
Practice Address - Fax:281-320-2012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-23
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6423TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX181511001Medicaid
TX181511001Medicaid
TX8B2295Medicare PIN