Provider Demographics
NPI:1386876985
Name:STEVEN R KLEEN OPTOMETRIC CORPORATION
Entity type:Organization
Organization Name:STEVEN R KLEEN OPTOMETRIC CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:
Authorized Official - Last Name:AVELAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-792-3457
Mailing Address - Street 1:363 ISLAND OAK LN
Mailing Address - Street 2:
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93117-2478
Mailing Address - Country:US
Mailing Address - Phone:909-792-3457
Mailing Address - Fax:909-307-1863
Practice Address - Street 1:2050 W REDLANDS BLVD
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-6228
Practice Address - Country:US
Practice Address - Phone:909-792-3457
Practice Address - Fax:909-307-1863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-14
Last Update Date:2018-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center