Provider Demographics
NPI:1417915075
Name:KLEIN, CHAD ERIC (OD)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:ERIC
Last Name:KLEIN
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 1:100 N 4TH AVE W
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:IA
Mailing Address - Zip Code:50208
Mailing Address - Country:US
Mailing Address - Phone:641-792-7900
Mailing Address - Fax:641-792-8663
Practice Address - Street 1:100 N 4TH AVE W
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:IA
Practice Address - Zip Code:50208
Practice Address - Country:US
Practice Address - Phone:641-792-7900
Practice Address - Fax:641-792-8663
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02331152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0474965Medicaid
IA02823OtherBCBS
IA19525OtherGROUP BCBS
IA0195255Medicaid
IAI16534Medicare ID - Type Unspecified
IA19525Medicare ID - Type UnspecifiedGROUP
IA0195255Medicaid