Provider Demographics
NPI:1114036167
Name:ROBERTS & JANASEK
Entity Type:Organization
Organization Name:ROBERTS & JANASEK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:L
Authorized Official - Last Name:LANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-681-0991
Mailing Address - Street 1:8150 E DOUGLAS AVE
Mailing Address - Street 2:SUITE 50
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-2376
Mailing Address - Country:US
Mailing Address - Phone:316-681-0991
Mailing Address - Fax:316-681-9931
Practice Address - Street 1:8150 E DOUGLAS AVE
Practice Address - Street 2:SUITE 50
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2376
Practice Address - Country:US
Practice Address - Phone:316-681-0991
Practice Address - Fax:316-681-9931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1201-2152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KST80112Medicare UPIN
KST77043Medicare UPIN
KS065156Medicare PIN
KS0548150002Medicare NSC
KSU36734Medicare UPIN