Provider Demographics
NPI:1003993908
Name:KLINE, PETER BRICE (OD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:BRICE
Last Name:KLINE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6755 BANDERA RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-1438
Mailing Address - Country:US
Mailing Address - Phone:210-684-5212
Mailing Address - Fax:210-684-5232
Practice Address - Street 1:6755 BANDERA RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-1438
Practice Address - Country:US
Practice Address - Phone:210-684-5212
Practice Address - Fax:210-684-5232
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX2326152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX741891275OtherIRS INDIVIDUAL TAXPAYER I