Provider Demographics
NPI:1821098401
Name:KLECKER, STEVEN A (OD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:A
Last Name:KLECKER
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 1:1555 E NEW CIRCLE RD
Mailing Address - Street 2:SUITE #146
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1043
Mailing Address - Country:US
Mailing Address - Phone:859-269-6921
Mailing Address - Fax:859-266-9504
Practice Address - Street 1:1555 E NEW CIRCLE RD
Practice Address - Street 2:SUITE #146
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1043
Practice Address - Country:US
Practice Address - Phone:859-269-6921
Practice Address - Fax:859-266-9504
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY844DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77008449Medicaid
KY0923602OtherFEDERAL MEDICARE ID
KY0923602OtherFEDERAL MEDICARE ID