Provider Demographics
NPI:1811918360
Name:KLEMKE, MATTHEW F (OD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:F
Last Name:KLEMKE
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 1:304 N. 179TH STREET
Mailing Address - Street 2:SUITE 203
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68118-3569
Mailing Address - Country:US
Mailing Address - Phone:402-614-4322
Mailing Address - Fax:402-614-4475
Practice Address - Street 1:304 NORTH 179TH STREET
Practice Address - Street 2:SUITE 203
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68118-3569
Practice Address - Country:US
Practice Address - Phone:402-614-4322
Practice Address - Fax:402-614-4475
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1178152W00000X, 152WC0802X, 152WP0200X, 152WS0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE37054OtherBCBS
NEP00219077OtherRAILROAD MEDICARE DD2869
NE37054OtherBCBS
NE278795Medicare ID - Type UnspecifiedGROUP 099680