Provider Demographics
NPI:1639392509
Name:DR. JIL KLEIN - DELMARVA VISION ASSOC'S, P.C.
Entity Type:Organization
Organization Name:DR. JIL KLEIN - DELMARVA VISION ASSOC'S, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JIL
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:410-334-3900
Mailing Address - Street 1:1504 S SALISBURY BLVD
Mailing Address - Street 2:SUITE #20
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-7165
Mailing Address - Country:US
Mailing Address - Phone:410-334-3900
Mailing Address - Fax:410-334-3955
Practice Address - Street 1:1504 S SALISBURY BLVD
Practice Address - Street 2:SUITE #20
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-7165
Practice Address - Country:US
Practice Address - Phone:410-334-3900
Practice Address - Fax:410-334-3955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1384152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD546991-05OtherBC BS
MD3116528OtherUNITED HEALTH CARE
MDR5850001OtherBC BS FEDERAL
MDR5850001OtherBC BS FEDERAL
MD562M871FMedicare ID - Type Unspecified