Provider Demographics
NPI:1245341429
Name:KLINE, REBECCA J (OD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:J
Last Name:KLINE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:REBECCA
Other - Middle Name:J
Other - Last Name:CZERWINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:3710 SW VETERANS HOSPITAL RD
Mailing Address - Street 2:P3-EYE PO BOX 1034
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-2964
Mailing Address - Country:US
Mailing Address - Phone:503-220-8262
Mailing Address - Fax:
Practice Address - Street 1:3710 SW VETERANS HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-2964
Practice Address - Country:US
Practice Address - Phone:503-220-8262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2900T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR299810Medicaid
R117119Medicare ID - Type Unspecified
OR299810Medicaid