Provider Demographics
NPI:1346347044
Name:RIMKUS, JOHN J (OD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:RIMKUS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8309 N KNOXVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-2170
Mailing Address - Country:US
Mailing Address - Phone:309-693-9540
Mailing Address - Fax:309-693-9754
Practice Address - Street 1:8309 N KNOXVILLE AVE STE 1
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-2171
Practice Address - Country:US
Practice Address - Phone:309-713-3664
Practice Address - Fax:309-839-0078
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046007838152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046007838Medicaid
T34993Medicare UPIN
IL046007838Medicaid
206330002Medicare PIN
347300002Medicare PIN
206332002Medicare PIN