Provider Demographics
NPI:1346429503
Name:JANVIER, JOHN (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:JANVIER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 MALPHRUS RD
Mailing Address - Street 2:STE 101
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-6635
Mailing Address - Country:US
Mailing Address - Phone:843-837-4545
Mailing Address - Fax:843-837-4474
Practice Address - Street 1:3 MALPHRUS RD
Practice Address - Street 2:STE 101
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-6635
Practice Address - Country:US
Practice Address - Phone:843-837-4545
Practice Address - Fax:843-837-4474
Is Sole Proprietor?:No
Enumeration Date:2007-10-24
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC0941152W00000X
SCSC551152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD05518Medicaid
SCD05518Medicaid