Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | TA1384 | MD |
NPI | 1174644892 |
---|---|
Provider Name | Dr. Jil Klein |
First Address | Salisbury, MD 21801-7165 |
Second Address | Salisbury, MD 21804 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3116528 | UNITEDHEALTHCARE (01) | MD |
54699105 | BLUECROSSBLUESHIELD (01) | MD |
R5850001 | FEDERALBLUECROSSBLUESHIE (01) | MD |
T81500 | (02) |