Provider Demographics
NPI:1336317080
Name:STEVEN KLECKER
Entity Type:Organization
Organization Name:STEVEN KLECKER
Other - Org Name:STEVEN KLECKER OPTOMETRIST
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:AMBROSE
Authorized Official - Last Name:KLECKER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:859-269-6921
Mailing Address - Street 1:1555 E NEW CIRCLE RD STE 146
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1044
Mailing Address - Country:US
Mailing Address - Phone:859-269-6921
Mailing Address - Fax:859-266-9504
Practice Address - Street 1:1555 E NEW CIRCLE RD STE 146
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1044
Practice Address - Country:US
Practice Address - Phone:859-269-6921
Practice Address - Fax:859-266-9504
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEVEN KLECKER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-15
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY844DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77008449Medicaid
9836OtherMEDICARE GROUP ID
0983602Medicare PIN
9836OtherMEDICARE GROUP ID