Provider Demographics
NPI:1255393849
Name:JANKOWSKI, CHRISTEN (OD)
Entity type:Individual
Prefix:DR
First Name:CHRISTEN
Middle Name:
Last Name:JANKOWSKI
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 1:14415 SE MILL PLAIN BLVD
Mailing Address - Street 2:STE 115B
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684
Mailing Address - Country:US
Mailing Address - Phone:360-253-4405
Mailing Address - Fax:360-253-2233
Practice Address - Street 1:14415 SE MILL PLAIN BLVD
Practice Address - Street 2:STE 115B
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684
Practice Address - Country:US
Practice Address - Phone:360-253-4405
Practice Address - Fax:360-253-2233
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWA1596TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2008217Medicaid
WAG000615426Medicare PIN
WA4575500001Medicare NSC
WA2008217Medicaid