Provider Demographics
NPI:1598760894
Name:KLEINAU, KARL JURGEN (OD)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:JURGEN
Last Name:KLEINAU
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6035 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3256
Mailing Address - Country:US
Mailing Address - Phone:704-295-3000
Mailing Address - Fax:704-838-8494
Practice Address - Street 1:400 PARK ST
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:NC
Practice Address - Zip Code:28012-3368
Practice Address - Country:US
Practice Address - Phone:704-295-3700
Practice Address - Fax:704-295-3707
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1392152W00000X
SC1165152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5107023OtherAETNA
SCDN1392Medicaid
NCNC1392OtherEYEMED
NC0905ROtherBCBS OF NORTH CAROLINA
NC2241738OtherUNITED HEALTHCARE
SC20096067OtherSELECT HEALTH OF SC
NC890905RMedicaid
SC20096067OtherSELECT HEALTH OF SC
NC2241738OtherUNITED HEALTHCARE