Provider Demographics
NPI:1194757609
Name:KARL KLEINAU
Entity type:Organization
Organization Name:KARL KLEINAU
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KARL
Authorized Official - Middle Name:JURGEN
Authorized Official - Last Name:KLEINAU
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:704-867-1392
Mailing Address - Street 1:246 N NEW HOPE RD
Mailing Address - Street 2:PO BOX 5131
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-4745
Mailing Address - Country:US
Mailing Address - Phone:707-867-1392
Mailing Address - Fax:
Practice Address - Street 1:246 N NEW HOPE RD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-4745
Practice Address - Country:US
Practice Address - Phone:707-867-1392
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1392152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0276HOtherBCBS
NC1392OtherEYEMED
NC2241738OtherUNITED HEALTHCARE OF NC
T59420Medicare UPIN
NC0276HOtherBCBS