Provider Demographics
NPI:1235214479
Name:KLING, MICHAEL A (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:KLING
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3945 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-3015
Mailing Address - Country:US
Mailing Address - Phone:619-295-4194
Mailing Address - Fax:619-295-4930
Practice Address - Street 1:3945 1ST AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-3015
Practice Address - Country:US
Practice Address - Phone:619-295-4194
Practice Address - Fax:619-295-4930
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10135T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0101350Medicaid
CASD0101350Medicaid
CAWOP10135HMedicare ID - Type Unspecified