Provider Demographics
NPI:1093708463
Name:KLINGER, RITA ELLEN (OD)
Entity Type:Individual
Prefix:DR
First Name:RITA
Middle Name:ELLEN
Last Name:KLINGER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:RITA
Other - Middle Name:ELLEN
Other - Last Name:KLINGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:324 E INDEPENDENCE ST
Mailing Address - Street 2:
Mailing Address - City:SHAMOKIN
Mailing Address - State:PA
Mailing Address - Zip Code:17872-6710
Mailing Address - Country:US
Mailing Address - Phone:570-648-4747
Mailing Address - Fax:
Practice Address - Street 1:324 E INDEPENDENCE ST
Practice Address - Street 2:
Practice Address - City:SHAMOKIN
Practice Address - State:PA
Practice Address - Zip Code:17872-6710
Practice Address - Country:US
Practice Address - Phone:570-648-4747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000601152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist