Provider Demographics
NPI:1467524223
Name:JOHN D POLANSKY MD PC
Entity Type:Organization
Organization Name:JOHN D POLANSKY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FRONT OFFICE LEAD
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:YOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-683-3744
Mailing Address - Street 1:2460 WILLAMETTE STREET
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405
Mailing Address - Country:US
Mailing Address - Phone:541-683-3744
Mailing Address - Fax:541-683-6672
Practice Address - Street 1:2460 WILLAMETTE STREET
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405
Practice Address - Country:US
Practice Address - Phone:541-683-3744
Practice Address - Fax:541-683-6672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORDG2806OtherRAILROAD MEDICARE
OR006379Medicaid
OR009139000OtherREGENCE BLUE CROSS
ORR0000BHFRCOtherMEDICARE
OR006379Medicaid
OR009139000OtherREGENCE BLUE CROSS
OR1467524223Medicare Oscar/Certification