Provider Demographics
NPI:1083771133
Name:POLONCAK, JAMES M (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:POLONCAK
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:3850 CALIBRE BEND LN
Mailing Address - Street 2:APT. 1109
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-8670
Mailing Address - Country:US
Mailing Address - Phone:407-657-1001
Mailing Address - Fax:
Practice Address - Street 1:8001 S ORANGE BLOSSOM TRL
Practice Address - Street 2:SUITE 552
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-7654
Practice Address - Country:US
Practice Address - Phone:407-854-6969
Practice Address - Fax:407-859-0699
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 3761152W00000X
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILMPO946333OtherDEA#
ILMPO946333OtherDEA#