Provider Demographics
NPI:1588993760
Name:JEFFREY W KLINK, O.D.
Entity type:Organization
Organization Name:JEFFREY W KLINK, O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:W
Authorized Official - Last Name:KLINK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:530-370-4703
Mailing Address - Street 1:PO BOX 1773
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95965-1773
Mailing Address - Country:US
Mailing Address - Phone:530-370-4703
Mailing Address - Fax:530-534-8811
Practice Address - Street 1:2162 ROBINSON ST
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95965-4937
Practice Address - Country:US
Practice Address - Phone:530-370-4703
Practice Address - Fax:530-534-8811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-16
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6847T332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0068470Medicaid
4121170001Medicare NSC
CAT10427Medicare UPIN