Provider Demographics
NPI:1437361284
Name:DEBORAH L KLIMEK, MD, PLLC
Entity Type:Organization
Organization Name:DEBORAH L KLIMEK, MD, PLLC
Other - Org Name:CHILDREN'S EYE CARE & ADULT STRABISMUS SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:KLIMEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-720-7001
Mailing Address - Street 1:24 MACCORKLE AVE SW
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25303-1476
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24 MACCORKLE AVE SW
Practice Address - Street 2:SUITE 203
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25303-1476
Practice Address - Country:US
Practice Address - Phone:304-720-7001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV55593261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2004970000Medicaid
WV2004970000Medicaid