Provider Demographics
NPI:1922177823
Name:CLINE, KERRY KEITH (OD)
Entity Type:Individual
Prefix:DR
First Name:KERRY
Middle Name:KEITH
Last Name:CLINE
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 1:12588 GOVERNOR G C PEERY HWY
Mailing Address - Street 2:
Mailing Address - City:POUNDING MILL
Mailing Address - State:VA
Mailing Address - Zip Code:24637-3549
Mailing Address - Country:US
Mailing Address - Phone:276-963-7400
Mailing Address - Fax:276-963-8778
Practice Address - Street 1:12588 GOVERNOR G C PEERY HWY
Practice Address - Street 2:
Practice Address - City:POUNDING MILL
Practice Address - State:VA
Practice Address - Zip Code:24637-3549
Practice Address - Country:US
Practice Address - Phone:276-963-7400
Practice Address - Fax:276-963-8778
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000966152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00V728K08Medicare PIN
VAU84923Medicare UPIN