Provider Demographics
NPI:1184806861
Name:DR JOHN KLEINHOFFER PC
Entity type:Organization
Organization Name:DR JOHN KLEINHOFFER PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:KLEINHOFFER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:618-654-9999
Mailing Address - Street 1:1312 MERCANTILE DR
Mailing Address - Street 2:WOODCREST PLAZA
Mailing Address - City:HIGHLAND
Mailing Address - State:IL
Mailing Address - Zip Code:62249-1240
Mailing Address - Country:US
Mailing Address - Phone:618-654-9999
Mailing Address - Fax:618-654-8430
Practice Address - Street 1:1312 MERCANTILE DR
Practice Address - Street 2:WOODCREST PLAZA
Practice Address - City:HIGHLAND
Practice Address - State:IL
Practice Address - Zip Code:62249-1240
Practice Address - Country:US
Practice Address - Phone:618-654-9999
Practice Address - Fax:618-654-8430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU47265Medicare UPIN
IL211845Medicare PIN
IL5426600001Medicare NSC
ILDD4601Medicare PIN