Provider Demographics
NPI:1386706174
Name:KLESERT, TODD ROBERT (MD, PHD)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:ROBERT
Last Name:KLESERT
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22232 17TH AVE SE STE 308
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-7425
Mailing Address - Country:US
Mailing Address - Phone:425-296-3837
Mailing Address - Fax:206-215-3870
Practice Address - Street 1:1750 112TH AVE NE
Practice Address - Street 2:SUITE D050
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3752
Practice Address - Country:US
Practice Address - Phone:206-215-3850
Practice Address - Fax:206-215-3870
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD 60125691207W00000X, 207W00000X
MN50034207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology