Provider Demographics
NPI:1093137317
Name:JM JANSSEN DBA PARAMOUNT OPTICAL LAB
Entity Type:Organization
Organization Name:JM JANSSEN DBA PARAMOUNT OPTICAL LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:M
Authorized Official - Last Name:JANSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-228-9295
Mailing Address - Street 1:6809 N GREEN BAY AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-2820
Mailing Address - Country:US
Mailing Address - Phone:414-228-9295
Mailing Address - Fax:414-228-1871
Practice Address - Street 1:6809 N GREEN BAY AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53209-2820
Practice Address - Country:US
Practice Address - Phone:414-228-9295
Practice Address - Fax:414-228-1871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-07
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty