Provider Demographics
NPI:1194808766
Name:KLESHINSKI, BRIAN (OD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:KLESHINSKI
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 1:1341 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907-2614
Mailing Address - Country:US
Mailing Address - Phone:419-756-0081
Mailing Address - Fax:419-756-1631
Practice Address - Street 1:1341 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-2614
Practice Address - Country:US
Practice Address - Phone:419-756-0081
Practice Address - Fax:419-756-1631
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2011-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3476/T565152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0448831Medicaid
OH0504253Medicare PIN
OH0448831Medicaid