Provider Demographics
NPI:1851369888
Name:JANOWIAK, JAMES L (OD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:L
Last Name:JANOWIAK
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 1:515 S MISSION ST
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-4655
Mailing Address - Country:US
Mailing Address - Phone:918-224-2389
Mailing Address - Fax:918-224-3919
Practice Address - Street 1:515 S MISSION ST
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-4655
Practice Address - Country:US
Practice Address - Phone:918-224-2389
Practice Address - Fax:918-224-3919
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1004152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100765580AMedicaid
OKT91540Medicare UPIN
OK100765580AMedicaid