Provider Demographics
NPI:1942208640
Name:POLANSKY, JOHN D (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:POLANSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2460 WILLAMETTE ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-3169
Mailing Address - Country:US
Mailing Address - Phone:541-683-3744
Mailing Address - Fax:541-683-6672
Practice Address - Street 1:2460 WILLAMETTE ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-3169
Practice Address - Country:US
Practice Address - Phone:541-683-3744
Practice Address - Fax:541-683-6672
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR09541207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0000BHFRCOtherMEDICARE LEGACY NO.
OR009139000OtherREGENCE BLUE CROSS
OR161042Medicaid
180031534OtherRAILROAD MEDICARE PTAN
OR009139000OtherREGENCE BLUE CROSS
OR139069Medicare PIN