Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 1455 | KS |
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 1455-3 | KS |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | T03213 | MO |
NPI | 1205911260 |
---|---|
Provider Name | Dr. Paul Alan Klenklen |
First Address | Overland Park, KS 66204-2364 |
Second Address | Overland Park, KS 66204-2364 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2006 |
Last Update Date | 12/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U56519 | (02) |