Provider Demographics
NPI:1699961789
Name:KLETT OCULOPLASTIC SURGERY, PC
Entity type:Organization
Organization Name:KLETT OCULOPLASTIC SURGERY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:KLETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-785-1766
Mailing Address - Street 1:46 PRINCE ST
Mailing Address - Street 2:SUITE 404
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1600
Mailing Address - Country:US
Mailing Address - Phone:203-785-1766
Mailing Address - Fax:203-772-3259
Practice Address - Street 1:46 PRINCE ST
Practice Address - Street 2:SUITE 404
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1600
Practice Address - Country:US
Practice Address - Phone:203-785-1766
Practice Address - Fax:203-772-3259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F29830Medicare UPIN