Provider Demographics
NPI:1992824015
Name:KLEIN, IRWIN J (OPHTHALMIC DISPENSER)
Entity type:Individual
Prefix:MR
First Name:IRWIN
Middle Name:J
Last Name:KLEIN
Suffix:
Gender:M
Credentials:OPHTHALMIC DISPENSER
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:432 BUSHEE RD
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02777-4207
Mailing Address - Country:US
Mailing Address - Phone:508-379-3613
Mailing Address - Fax:508-379-3679
Practice Address - Street 1:40 W 57TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-4001
Practice Address - Country:US
Practice Address - Phone:212-581-4967
Practice Address - Fax:212-586-6296
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3808156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician