Provider Demographics
NPI:1710953161
Name:KLINGE, THERESA K (OD)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:K
Last Name:KLINGE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7450 FRANCE AVE S
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4787
Mailing Address - Country:US
Mailing Address - Phone:952-832-8100
Mailing Address - Fax:952-832-8176
Practice Address - Street 1:7450 FRANCE AVE S
Practice Address - Street 2:SUITE 100
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4787
Practice Address - Country:US
Practice Address - Phone:952-832-8100
Practice Address - Fax:952-832-8176
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN2664152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN960561043682OtherPREFERREDONE
MN2202876OtherMEDICA
MN0800014OtherMEDICA DUEL SOLUTIONS
MNP00232837OtherRR MEDICARE
MN2349336OtherAMERICA'S PPO/TPA
MN381M8KLOtherBLUE CROSS BLUE SHIELD
MNP00232837OtherRR MEDICARE