Provider Demographics
NPI:1598864613
Name:KLINE & BOYD OPTOMETRISTS PLLC
Entity Type:Organization
Organization Name:KLINE & BOYD OPTOMETRISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:A
Authorized Official - Last Name:KLINE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:518-792-2345
Mailing Address - Street 1:41 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-3313
Mailing Address - Country:US
Mailing Address - Phone:518-792-2345
Mailing Address - Fax:518-792-1361
Practice Address - Street 1:41 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-3313
Practice Address - Country:US
Practice Address - Phone:518-792-2345
Practice Address - Fax:518-792-1361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV003653-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4696250001Medicare NSC
NYAA1140Medicare UPIN