Provider Demographics
NPI:1568407716
Name:KLINSKY, ROBERT JOSEPH (OD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JOSEPH
Last Name:KLINSKY
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 1:103 N PEARL ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:IL
Mailing Address - Zip Code:62254-1511
Mailing Address - Country:US
Mailing Address - Phone:618-537-6356
Mailing Address - Fax:618-537-6358
Practice Address - Street 1:103 N PEARL ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:IL
Practice Address - Zip Code:62254-1511
Practice Address - Country:US
Practice Address - Phone:618-537-6356
Practice Address - Fax:618-537-6358
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046007494152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL689710Medicare ID - Type Unspecified
ILP15950Medicare PIN
IL410011580Medicare PIN