Vivian M Kloke, OD
Optometrist in O Fallon, IL. Individual provider (NPI-1).
NPI number1346358645
StatusActive
Last updated in NPPESDec 12, 2019
Details
- NPI
- 1346358645
- Entity type
- Individual (NPI-1)
- Name
- Ms. Vivian M Kloke
- Credential
- OD
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Aug 27, 2006
- Certification date
- Dec 12, 2019
- Last updated
- Dec 12, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 152W00000X | Optometrist | 046008375 | IL | Yes |
Practice location
735 Insight AveO Fallon, IL 62269-2193
Phone 618-628-2903 · Fax 618-628-2913
Mailing address
735 Insight AveO Fallon, IL 62269-2193
Phone 618-628-2903 · Fax 618-628-2913
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All 15 Optometrist providers in O Fallon · All 1,289 providers in O Fallon
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