Provider Demographics
NPI:1568565133
Name:KLIM, JANE MARIA (OD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:MARIA
Last Name:KLIM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 SW GAGE BLVD
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-1892
Mailing Address - Country:US
Mailing Address - Phone:785-271-8989
Mailing Address - Fax:
Practice Address - Street 1:1107 SW GAGE BLVD
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-1892
Practice Address - Country:US
Practice Address - Phone:785-271-8989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1204-2152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSCI4708OtherRAILROAD MEDICARE GROUP
KS043317OtherBCBS
KS043317Medicare PIN
KS043317OtherBCBS
T77136Medicare UPIN