1639291628 NPI number — STEVEN T KLEIN OD & KIMBERLY PLATTNER OD A PROFESSIONAL CORPORATION

Table of content: (NPI 1639291628)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639291628 NPI number — STEVEN T KLEIN OD & KIMBERLY PLATTNER OD A PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEVEN T KLEIN OD & KIMBERLY PLATTNER OD A PROFESSIONAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TIERRASANTA VISION CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639291628
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/06/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1457
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RANCHO SANTA FE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92067-1457
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-742-3937
Provider Business Mailing Address Fax Number:
858-756-2804

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5990 SANTO RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92124-1192
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-571-8835
Provider Business Practice Location Address Fax Number:
858-571-6364
Provider Enumeration Date:
04/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PLATTNER
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
B
Authorized Official Title or Position:
CO-OWNER
Authorized Official Telephone Number:
619-742-3937

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DE3507 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: P00287239 . This is a "RAILROAD MEDICARE PIN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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