Provider Demographics
NPI:1326143157
Name:JANET S WHITE
Entity Type:Organization
Organization Name:JANET S WHITE
Other - Org Name:JANS OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-324-8608
Mailing Address - Street 1:PO BOX 163
Mailing Address - Street 2:
Mailing Address - City:WAUPUN
Mailing Address - State:WI
Mailing Address - Zip Code:53963-0163
Mailing Address - Country:US
Mailing Address - Phone:920-324-8608
Mailing Address - Fax:920-324-8699
Practice Address - Street 1:223 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WAUPUN
Practice Address - State:WI
Practice Address - Zip Code:53963-0163
Practice Address - Country:US
Practice Address - Phone:920-324-8608
Practice Address - Fax:920-324-8699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No156FX1202XEye and Vision Services ProvidersTechnician/TechnologistOptometric TechnicianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38709800Medicaid
WI410047488OtherRR MEDICARE
WI000047381Medicare PIN
0576180001Medicare NSC