NPIMap

Organization Active NPI

Kleinebreil Optometry PLLC

  • Optometrist
  • Gaylord, MI
National Provider Identifier
1255778270
Registry record updated Oct 2, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
4901004610 Issued in MI
Legal business name
KLEINEBREIL OPTOMETRY PLLC
Practice address
927 S Otsego Ave
Gaylord, MI 49735-1783
Phone
(989) 732-7518
Fax
(989) 732-4205
NPI assigned
May 30, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Anna Leah Tanke-Kleinebreil, O.D.
Title
President
Phone
(231) 215-0103

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X 4901004610 MI Primary
Corneal and Contact Management OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152WC0802X 4901004610 MI
Low Vision Rehabilitation OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152WL0500X 4901004610 MI

Addresses

Primary practice location

927 S Otsego Ave
Gaylord, MI 49735-1783

Mailing address

PO Box 421
Gaylord, MI 49734-0421
Phone (989) 732-7518

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20131231000328 MI Part B Supplier - Clinic/Group Practice 2062654429 Receives reassigned benefits from 3 practitioners
Practice locations: Gaylord, MI

National Provider Directory

National Provider Directory

Locations

1000 S Wisconsin Ave
Gaylord, MI 49735
Phone (989) 732-7518

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1369872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1380672000000",
    "number": "1255778270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 421",
            "city": "GAYLORD",
            "state": "MI",
            "postal_code": "497340421",
            "telephone_number": "989-732-7518",
            "fax_number": "989-732-4205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "927 S OTSEGO AVE",
            "city": "GAYLORD",
            "state": "MI",
            "postal_code": "497351783",
            "telephone_number": "989-732-7518",
            "fax_number": "989-732-4205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KLEINEBREIL OPTOMETRY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-30",
        "last_updated": "2013-10-02",
        "status": "A",
        "authorized_official_last_name": "TANKE-KLEINEBREIL",
        "authorized_official_first_name": "ANNA",
        "authorized_official_middle_name": "LEAH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "231-215-0103",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901004610",
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "MI",
            "license": "4901004610",
            "primary": false
        },
        {
            "code": "152WL0500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Low Vision Rehabilitation",
            "state": "MI",
            "license": "4901004610",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gaylord, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.