Provider Demographics
NPI:1518922202
Name:KLEVA, JULIE ELIZABETH (OD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:ELIZABETH
Last Name:KLEVA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:JULIE
Other - Middle Name:ELIZABETH
Other - Last Name:KARRER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:8801 HORIZON BLVD NE
Mailing Address - Street 2:SUITE 360
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-1533
Mailing Address - Country:US
Mailing Address - Phone:505-246-2622
Mailing Address - Fax:505-213-0103
Practice Address - Street 1:622 W MAPLE ST
Practice Address - Street 2:SUITE E
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-6590
Practice Address - Country:US
Practice Address - Phone:505-325-4003
Practice Address - Fax:505-327-6140
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2477152W00000X
NM577152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO42682045Medicaid
NM76524230Medicaid
CO803721Medicare ID - Type Unspecified
CO42682045Medicaid
NM76524230Medicaid