Provider Demographics
NPI:1841254125
Name:KLINE, ROY A (OD)
Entity type:Individual
Prefix:DR
First Name:ROY
Middle Name:A
Last Name:KLINE
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 1:11 SHALLOW CREEK RD
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-1040
Mailing Address - Country:US
Mailing Address - Phone:518-796-6612
Mailing Address - Fax:
Practice Address - Street 1:1636 ULSTER AVE
Practice Address - Street 2:
Practice Address - City:LAKE KATRINE
Practice Address - State:NY
Practice Address - Zip Code:12449-5420
Practice Address - Country:US
Practice Address - Phone:845-336-6310
Practice Address - Fax:845-336-8573
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2025-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV003653-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT26680Medicare UPIN
NYDD0680Medicare PIN
NY4696250001Medicare NSC