Provider Demographics
NPI:1194817031
Name:JANSEN, CHERYL F (OD)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:F
Last Name:JANSEN
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:3601 W WILLIAM CANNON DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-1525
Mailing Address - Country:US
Mailing Address - Phone:512-441-8924
Mailing Address - Fax:512-442-4858
Practice Address - Street 1:3601 W WILLIAM CANNON DR
Practice Address - Street 2:SUITE 150
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-1525
Practice Address - Country:US
Practice Address - Phone:512-441-8924
Practice Address - Fax:512-442-4858
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX3560T152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
E80612Medicare UPIN