Provider Demographics
NPI:1659863835
Name:KLOC, MEGAN MARGARET
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:MARGARET
Last Name:KLOC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5458 ERIE STATION LN APT 67
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45227-2585
Mailing Address - Country:US
Mailing Address - Phone:317-938-0410
Mailing Address - Fax:
Practice Address - Street 1:8118 CORPORATE WAY
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-7350
Practice Address - Country:US
Practice Address - Phone:513-947-8433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-04
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
37966OtherBLUE CROSS BLUE SHIELD OF ALABAMA