Provider Demographics
NPI:1477524775
Name:YZEIK, JANELL R (OD)
Entity Type:Individual
Prefix:DR
First Name:JANELL
Middle Name:R
Last Name:YZEIK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JANELL
Other - Middle Name:R
Other - Last Name:YZEIK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:25 BROOKSIDE RD
Mailing Address - Street 2:
Mailing Address - City:WAYMART
Mailing Address - State:PA
Mailing Address - Zip Code:18472-9352
Mailing Address - Country:US
Mailing Address - Phone:570-488-7400
Mailing Address - Fax:570-488-7403
Practice Address - Street 1:25 BROOKSIDE RD
Practice Address - Street 2:
Practice Address - City:WAYMART
Practice Address - State:PA
Practice Address - Zip Code:18472-9352
Practice Address - Country:US
Practice Address - Phone:570-488-7400
Practice Address - Fax:570-488-7403
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000843152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014401920003Medicaid
PA410025979OtherRAILROAD MEDICARE
PAPA7628OtherVISION BENEFITS OF AMERIC
PATE518839OtherPA BC/BS
PA078420OtherFIRST PRIORITY HEALTH
PA26255OtherGEISINGER HEALTH PLAN
PA42075OtherDAVIS VISION
PA397341OtherNATIONAL VISION ADMINISTR
PA912359OtherEYEMED/COLE
PA397341OtherNATIONAL VISION ADMINISTR
PA42075OtherDAVIS VISION
PA912359OtherEYEMED/COLE