Provider Demographics
NPI:1396723300
Name:KLINE, JON A (OD)
Entity type:Individual
Prefix:DR
First Name:JON
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 1:7351 LAKE SHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-3552
Mailing Address - Country:US
Mailing Address - Phone:440-257-4311
Mailing Address - Fax:440-257-0666
Practice Address - Street 1:7351 LAKE SHORE BLVD
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-3552
Practice Address - Country:US
Practice Address - Phone:440-257-4311
Practice Address - Fax:440-257-0666
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2986 T748152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0224886Medicaid
OHT46963Medicare UPIN
OH0452571Medicare ID - Type Unspecified