Provider Demographics
NPI:1225390677
Name:KLEINSORGE FAMILY EYECARE INC
Entity Type:Organization
Organization Name:KLEINSORGE FAMILY EYECARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:KLEINSORGE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:570-242-8957
Mailing Address - Street 1:5520 ELMWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:TANNERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18372-7746
Mailing Address - Country:US
Mailing Address - Phone:570-242-8957
Mailing Address - Fax:570-421-5632
Practice Address - Street 1:7740 RTE 611 STROUD COMMONS
Practice Address - Street 2:SUITE 2A
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-6501
Practice Address - Country:US
Practice Address - Phone:570-421-2332
Practice Address - Fax:570-421-5632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG-1754152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty