Provider Demographics
NPI:1770331092
Name:KLASE, KATHRYN (ABOC)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:KLASE
Suffix:
Gender:F
Credentials:ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 AJK BLVD
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-7491
Mailing Address - Country:US
Mailing Address - Phone:570-522-8224
Mailing Address - Fax:570-522-0689
Practice Address - Street 1:120 AJK BLVD
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-7491
Practice Address - Country:US
Practice Address - Phone:570-522-8224
Practice Address - Fax:570-522-0689
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA253090156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician