Provider Demographics
NPI:1790727956
Name:KLINGER, BRIAN S (OD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:S
Last Name:KLINGER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:466 WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:RYE
Mailing Address - State:NH
Mailing Address - Zip Code:03870-2451
Mailing Address - Country:US
Mailing Address - Phone:603-964-6235
Mailing Address - Fax:
Practice Address - Street 1:161 DEER ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-3905
Practice Address - Country:US
Practice Address - Phone:603-436-3717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0226152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30352795Medicaid
T25674Medicare UPIN
NH30352795Medicaid