Provider Demographics
NPI:1760550768
Name:MICHAEL A. KLING OD, INC
Entity Type:Organization
Organization Name:MICHAEL A. KLING OD, INC
Other - Org Name:INVISION EYE CARE - OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:LANCASTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-295-4194
Mailing Address - Street 1:3945 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-3015
Mailing Address - Country:US
Mailing Address - Phone:619-295-4194
Mailing Address - Fax:619-295-4930
Practice Address - Street 1:3945 1ST AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-3015
Practice Address - Country:US
Practice Address - Phone:619-295-4194
Practice Address - Fax:619-295-4930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10135T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADF2547OtherRAILROAD MEDICARE
CAZZZ67689ZOtherBLUESHIELD
CA0909134Medicaid
CA1235214479OtherBLUECROSS
CAZZZ67689ZOtherBLUESHIELD
CAWY165Medicare PIN