Provider Demographics
NPI:1467508556
Name:KLIBANOFF EYE ASSOCIATES, LTD
Entity Type:Organization
Organization Name:KLIBANOFF EYE ASSOCIATES, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:KLIBANOFF
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:401-723-3400
Mailing Address - Street 1:121 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-2053
Mailing Address - Country:US
Mailing Address - Phone:401-723-3400
Mailing Address - Fax:401-727-2326
Practice Address - Street 1:121 BROAD ST
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-2053
Practice Address - Country:US
Practice Address - Phone:401-723-3400
Practice Address - Fax:401-727-2326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIODTG00476152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI0236250001Medicare NSC
RI419007949Medicare PIN