Provider Demographics
NPI:1710469705
Name:KLEIN, JOHN TYLER (OD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:TYLER
Last Name:KLEIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9955 GILLESPIE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-7533
Mailing Address - Country:US
Mailing Address - Phone:972-403-1110
Mailing Address - Fax:972-403-1153
Practice Address - Street 1:9955 GILLESPIE DR STE 100
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75025-7533
Practice Address - Country:US
Practice Address - Phone:972-403-1110
Practice Address - Fax:972-403-1153
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT.0003433152W00000X
TX11155TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist