Provider Demographics
NPI:1639174378
Name:KLINK, JEFFREY W (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:W
Last Name:KLINK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1689 ARDEN WAY
Mailing Address - Street 2:#1344
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-4030
Mailing Address - Country:US
Mailing Address - Phone:916-922-1977
Mailing Address - Fax:916-922-4373
Practice Address - Street 1:1689 ARDEN WAY
Practice Address - Street 2:#1344
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-4030
Practice Address - Country:US
Practice Address - Phone:916-922-1977
Practice Address - Fax:916-922-4373
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA6847T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0068470Medicaid
CA4121170001Medicare NSC
CASD0068470Medicaid