Provider Demographics
NPI:1548323280
Name:KLINE, SANDY ROBIN (OD)
Entity type:Individual
Prefix:DR
First Name:SANDY
Middle Name:ROBIN
Last Name:KLINE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:22 DALE DR
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-2006
Mailing Address - Country:US
Mailing Address - Phone:973-736-4498
Mailing Address - Fax:973-574-8223
Practice Address - Street 1:7508 BELL BLVD
Practice Address - Street 2:APT 1P
Practice Address - City:OAKLAND GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11364-3403
Practice Address - Country:US
Practice Address - Phone:973-736-4498
Practice Address - Fax:973-574-8223
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-17
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4593152W00000X
NY4586152W00000X
PA6494P152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC60861Medicare ID - Type Unspecified