Provider Demographics
NPI:1558562835
Name:PAUL J JANIS OD INC
Entity Type:Organization
Organization Name:PAUL J JANIS OD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:JANIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:317-738-2181
Mailing Address - Street 1:950 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-2122
Mailing Address - Country:US
Mailing Address - Phone:317-738-2181
Mailing Address - Fax:317-738-4736
Practice Address - Street 1:950 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-2122
Practice Address - Country:US
Practice Address - Phone:317-738-2181
Practice Address - Fax:317-738-4736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002592152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
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IN200387820Medicaid
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IN200387820Medicaid
IN0263910001Medicare NSC