Provider Demographics
NPI:1891873832
Name:KLINNERT, RICHARD LEE (OD)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:LEE
Last Name:KLINNERT
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 1:1207 OLD FAIRHAVEN PKWY
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-7411
Mailing Address - Country:US
Mailing Address - Phone:360-733-1190
Mailing Address - Fax:360-734-1306
Practice Address - Street 1:1207 OLD FAIRHAVEN PKWY
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-7411
Practice Address - Country:US
Practice Address - Phone:360-733-1190
Practice Address - Fax:360-734-1306
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00003409152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
A003OtherTRICARE
4125KLOtherREGENCE
WA2025211Medicaid
WAG8805139Medicare PIN
4125KLOtherREGENCE
A003OtherTRICARE