Provider Demographics
NPI:1851367288
Name:KLIM, WAYNE (OD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:
Last Name:KLIM
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 1:919 GAP NEWPORT PIKE
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19311-9531
Mailing Address - Country:US
Mailing Address - Phone:610-268-3220
Mailing Address - Fax:
Practice Address - Street 1:919 GAP NEWPORT PIKE
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:PA
Practice Address - Zip Code:19311-9531
Practice Address - Country:US
Practice Address - Phone:610-268-3220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-25
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001520152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU64678Medicare UPIN
PA073018Medicare ID - Type Unspecified