Provider Demographics
NPI:1306402771
Name:KLEES, EVAN (R EEG T)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:
Last Name:KLEES
Suffix:
Gender:M
Credentials:R EEG T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1237 E DUST DEVIL DR
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85143-4287
Mailing Address - Country:US
Mailing Address - Phone:570-854-0790
Mailing Address - Fax:
Practice Address - Street 1:1237 E DUST DEVIL DR
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85143-4287
Practice Address - Country:US
Practice Address - Phone:157-085-4979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-11
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA7039156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist