Provider Demographics
NPI:1477523223
Name:KLINE, ROBERT EUGENE (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EUGENE
Last Name:KLINE
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 1:5455 HARRISON PARK LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46216-2245
Mailing Address - Country:US
Mailing Address - Phone:317-254-6480
Mailing Address - Fax:317-259-8609
Practice Address - Street 1:1111 N LEBANON ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:IN
Practice Address - Zip Code:46052-1760
Practice Address - Country:US
Practice Address - Phone:765-482-2066
Practice Address - Fax:765-482-4847
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001763A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100063210AMedicaid
IN22000000331180OtherANTHEM BLUE CROSS
IN351471010OtherVISION CARE PLAN
IN410002440OtherRAILROAD MEDICARE
INT34529Medicare UPIN
IN081030Medicare ID - Type Unspecified
IN410002440OtherRAILROAD MEDICARE
IN22000000331180OtherANTHEM BLUE CROSS