Provider Demographics
NPI:1205911260
Name:KLENKLEN, PAUL ALAN (OD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ALAN
Last Name:KLENKLEN
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 1:7701 FRONTAGE RD STE A
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66204-2364
Mailing Address - Country:US
Mailing Address - Phone:913-648-3072
Mailing Address - Fax:913-648-6597
Practice Address - Street 1:7701 FRONTAGE RD STE A
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66204-2364
Practice Address - Country:US
Practice Address - Phone:913-648-3072
Practice Address - Fax:913-648-6597
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1455152WC0802X
MOT03213152WC0802X
KS1455-3152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSKA2698001Medicare PIN
U56519Medicare UPIN
KS651011Medicare PIN
KS065083Medicare PIN
KSKA2698Medicare PIN