Provider Demographics
NPI:1528884772
Name:KLEE, THERESA
Entity type:Individual
Prefix:MS
First Name:THERESA
Middle Name:
Last Name:KLEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 2519
Mailing Address - Street 2:
Mailing Address - City:WINDOW ROCK
Mailing Address - State:AZ
Mailing Address - Zip Code:86515
Mailing Address - Country:US
Mailing Address - Phone:928-871-3463
Mailing Address - Fax:
Practice Address - Street 1:264 SRT-12 DINEH OPTICAL HIWY NAVAJO NATION SHOPING CEN
Practice Address - Street 2:SUITE 12
Practice Address - City:WINDOW ROCK
Practice Address - State:AZ
Practice Address - Zip Code:86515
Practice Address - Country:US
Practice Address - Phone:928-871-3463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician