Individual
DR. KELLY L KLEIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
511 PALMYRA STREET, KSB EYE & VISION CARE, DIXON, IL 61021
(815) 284-2020
(815) 284-8326
Mailing address
511 PALMYRA STREET, KSB EYE & VISION CARE, DIXON, IL 61021
(815) 284-2020
(815) 284-8326
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046-010280
IL
152W00000X
Optometrist
046010280
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046010280
—
IL
01
—
F400136585
MEDICARE
IL
Enumeration date
08/11/2009
Last updated
08/23/2018
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