Provider Demographics
NPI:1407414246
Name:KLIMCHAK, JUSTIN ROBERT (OD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:ROBERT
Last Name:KLIMCHAK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:106 ROCKY MOUNTAIN CT
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-2409
Mailing Address - Country:US
Mailing Address - Phone:724-244-3455
Mailing Address - Fax:
Practice Address - Street 1:100 ROBINSON CENTER DR STE 2870
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15205-4831
Practice Address - Country:US
Practice Address - Phone:412-490-0820
Practice Address - Fax:412-490-2570
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-05
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003521152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist