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Individual

MS. VIVIAN M KLOKE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
OD

Contact information

Practice address
735 INSIGHT AVE, O FALLON, IL 62269-2193
(618) 628-2903
(618) 628-2913
Mailing address
735 INSIGHT AVE, O FALLON, IL 62269-2193
(618) 628-2903
(618) 628-2913

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046008375
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
046008375
IL
01
08206037
BCBS
IL
01
1801926340
TIN FOR OFFICE
IL
01
2202035
UNITED HEALTHCARE
01
259903
HEALTHLINK
IL
01
400662
GROUP HEALTH PLAN
Enumeration date
08/27/2006
Last updated
12/12/2019
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