Provider Demographics
NPI:1962719294
Name:KLEIN, AMY ELAINE (OD)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:ELAINE
Last Name:KLEIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18013 DEWEY CIR
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:NE
Mailing Address - Zip Code:68022-5670
Mailing Address - Country:US
Mailing Address - Phone:308-238-4630
Mailing Address - Fax:402-289-2253
Practice Address - Street 1:106 MEYER AVE
Practice Address - Street 2:BLDG 166
Practice Address - City:OFFUTT AFB
Practice Address - State:NE
Practice Address - Zip Code:68113
Practice Address - Country:US
Practice Address - Phone:402-292-0396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1346152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist