Provider Demographics
NPI:1528148830
Name:KLEIN, TREVOR LEE (OD)
Entity type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:LEE
Last Name:KLEIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 BATESVILLE RD
Mailing Address - Street 2:UNIT 201
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-4815
Mailing Address - Country:US
Mailing Address - Phone:864-288-7070
Mailing Address - Fax:864-288-6500
Practice Address - Street 1:404 MCCRAVY DR
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3178
Practice Address - Country:US
Practice Address - Phone:864-585-2249
Practice Address - Fax:864-585-3020
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1505152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47073266107Medicaid
NE47073266107Medicaid
NE277253Medicare ID - Type Unspecified