Provider Demographics
NPI:1124098744
Name:KLINE, KRIS A (OD)
Entity type:Individual
Prefix:DR
First Name:KRIS
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 1:1340 N COURT ST
Mailing Address - Street 2:
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43113-1091
Mailing Address - Country:US
Mailing Address - Phone:740-477-3937
Mailing Address - Fax:740-474-6098
Practice Address - Street 1:1340 N COURT ST
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-1091
Practice Address - Country:US
Practice Address - Phone:740-477-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4025152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0598710001OtherNATIONAL GOVERNMENT SERVICES
206663067002OtherMEDICAL MUTUAL
OH206663067001OtherMEDICAL MUTUAL
OH000000213315OtherBLUE CROSS BLUE SHIELD
OH0726558Medicaid
OH6273220Medicare PIN
OH206663067001OtherMEDICAL MUTUAL
OH0598710001Medicare NSC