Organization
KLEINEBREIL OPTOMETRY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANNA LEAH TANKE-KLEINEBREIL O.D. (PRESIDENT)
(231) 215-0103
Entity
Organization
Contact information
Practice address
927 S OTSEGO AVE, GAYLORD, MI 49735-1783
(989) 732-7518
(989) 732-4205
Mailing address
PO BOX 421, GAYLORD, MI 49734-0421
(989) 732-7518
(989) 732-4205
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901004610
MI
152WC0802X
Corneal and Contact Management Optometrist
4901004610
MI
152WL0500X
Low Vision Rehabilitation Optometrist
4901004610
MI
Other
Enumeration date
05/30/2013
Last updated
10/02/2013
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