Provider Demographics
NPI:1821270539
Name:KERRY CLINE & ASSOCIATES INC
Entity Type:Organization
Organization Name:KERRY CLINE & ASSOCIATES INC
Other - Org Name:DR KERRY CLINE
Other - Org Type:Other Name
Authorized Official - Title/Position:OPTOMETRIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:CLINE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:276-963-7400
Mailing Address - Street 1:113 SHORT ST
Mailing Address - Street 2:
Mailing Address - City:POUNDING MILL
Mailing Address - State:VA
Mailing Address - Zip Code:24637-4189
Mailing Address - Country:US
Mailing Address - Phone:276-963-7400
Mailing Address - Fax:276-963-8778
Practice Address - Street 1:113 SHORT ST
Practice Address - Street 2:
Practice Address - City:POUNDING MILL
Practice Address - State:VA
Practice Address - Zip Code:24637-4189
Practice Address - Country:US
Practice Address - Phone:276-963-7400
Practice Address - Fax:276-963-8778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000966152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5244030001Medicare NSC
VAU84923Medicare UPIN
VAC08908Medicare PIN