Provider Demographics
NPI:1649276528
Name:KLING, KENNETH H (OD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:H
Last Name:KLING
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:PO BOX 374
Mailing Address - Street 2:
Mailing Address - City:WAUSEON
Mailing Address - State:OH
Mailing Address - Zip Code:43567-0374
Mailing Address - Country:US
Mailing Address - Phone:419-335-3055
Mailing Address - Fax:419-335-3065
Practice Address - Street 1:1162 N SHOOP AVE
Practice Address - Street 2:
Practice Address - City:WAUSEON
Practice Address - State:OH
Practice Address - Zip Code:43567-1818
Practice Address - Country:US
Practice Address - Phone:419-335-3055
Practice Address - Fax:419-335-3065
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2987T518152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH03180OtherPARAMOUNT
OH0168465Medicaid
OH003304OtherVISION SERVICE PLAN
OH0168465Medicaid
OH03180OtherPARAMOUNT
OHKL9129592Medicare ID - Type Unspecified
OH791870106Medicare PIN