Individual
DR. GREGORY B KLOESEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
101 RIVER OAKS DR, STE 100, SOUTHLAKE, TX 76092
(817) 562-2101
(817) 562-2201
Mailing address
101 RIVER OAKS DR, STE 100, SOUTHLAKE, TX 76092
(817) 562-2101
(817) 562-2201
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4107TG
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8F9265
MEDICARE INDIVIDUAL PTAN
TX
Enumeration date
08/12/2005
Last updated
12/16/2008
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