Provider Demographics
NPI:1710256110
Name:DAVID M KLEIN, M.D., OPHTHALMOLOGIST, P.A.
Entity Type:Organization
Organization Name:DAVID M KLEIN, M.D., OPHTHALMOLOGIST, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-764-0035
Mailing Address - Street 1:1600 TAMIAMI TRL
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-1017
Mailing Address - Country:US
Mailing Address - Phone:941-764-0035
Mailing Address - Fax:941-764-0037
Practice Address - Street 1:1600 TAMIAMI TRL
Practice Address - Street 2:SUITE 101
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-1017
Practice Address - Country:US
Practice Address - Phone:941-764-0035
Practice Address - Fax:941-764-0037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0034395207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD61539Medicare UPIN