Provider Demographics
NPI:1720058316
Name:KLOSTERMAN, JEFFREY A (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:A
Last Name:KLOSTERMAN
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 1:300 SEXTON RD
Mailing Address - Street 2:
Mailing Address - City:HARRODSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40330-8939
Mailing Address - Country:US
Mailing Address - Phone:859-797-4609
Mailing Address - Fax:
Practice Address - Street 1:125 COLLIN DRIVE
Practice Address - Street 2:
Practice Address - City:HARRODSBURG
Practice Address - State:KY
Practice Address - Zip Code:40330
Practice Address - Country:US
Practice Address - Phone:859-734-3697
Practice Address - Fax:859-734-3695
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1674DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1720058316OtherINDIVIDUAL NPI
KY77001618Medicaid
KY77001618Medicaid
KY1720058316OtherINDIVIDUAL NPI