MEDICARE: BRIAN KLESHINSKI OD INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	3476 T565	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972813426
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIAN KLESHINSKI OD INC

Provider Business Mailing Address
First Line	:	1341 LEXINGTON AVE
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44907-2614
Country	:	US
Telephone Number	:	419-756-0081
Fax Number	:

Provider Business Practice Location Address
First Line	:	1341 LEXINGTON AVE
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44907-2614
Country	:	US
Telephone Number	:	419-756-0081
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BRIAN KLESHINSKI
Credential	:	O.D.
Telephone Number	:	419-756-0081

Provider Enumeration Date	:	10/18/2010
Last Update Date	:	11/28/2011

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