Provider Demographics
NPI:1417171588
Name:DR. JIL KLEIN - OCEAN PINES VISION CARE, PC
Entity Type:Organization
Organization Name:DR. JIL KLEIN - OCEAN PINES VISION CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JIL
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:410-208-4949
Mailing Address - Street 1:11002 MANKLIN MEADOW LANE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:OCEAN PINES
Mailing Address - State:MD
Mailing Address - Zip Code:21811
Mailing Address - Country:US
Mailing Address - Phone:410-208-4949
Mailing Address - Fax:410-208-4955
Practice Address - Street 1:11002 MANKLIN MEADOW LANE
Practice Address - Street 2:SUITE 6
Practice Address - City:OCEAN PINES
Practice Address - State:MD
Practice Address - Zip Code:21811
Practice Address - Country:US
Practice Address - Phone:410-208-4949
Practice Address - Fax:410-208-4955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1384152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG9150001OtherBC BS FEDERAL
MD2116528OtherUNITED HEALTH CARE
MD546991-06OtherBC BS
MD561MMedicare PIN
MD2116528OtherUNITED HEALTH CARE