Provider Demographics
NPI:1659510113
Name:PAUL KLENKLEN O.D., LLC
Entity Type:Organization
Organization Name:PAUL KLENKLEN O.D., LLC
Other - Org Name:KLENKLEN EYECARE
Other - Org Type:Other Name
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:KLENKLEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:785-272-3782
Mailing Address - Street 1:6137 ANTIOCH RD
Mailing Address - Street 2:
Mailing Address - City:MERRIAM
Mailing Address - State:KS
Mailing Address - Zip Code:66202-2826
Mailing Address - Country:US
Mailing Address - Phone:785-272-3782
Mailing Address - Fax:785-272-5413
Practice Address - Street 1:1501 SW WANAMAKER RD
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-3803
Practice Address - Country:US
Practice Address - Phone:785-272-3782
Practice Address - Fax:785-272-3782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-06
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS 1455-3152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSU56519Medicare UPIN
KS651011Medicare PIN
KS065083Medicare PIN
KSK618885Medicare PIN
KSK610000Medicare PIN